Healthcare Provider Details

I. General information

NPI: 1942286356
Provider Name (Legal Business Name): RODRIGO ANZOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S. CONWAY ROAD
ORLANDO FL
32812
US

IV. Provider business mailing address

P.O. BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-1000
  • Fax: 407-281-1432
Mailing address:
  • Phone: 407-447-7105
  • Fax: 407-770-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: