Healthcare Provider Details

I. General information

NPI: 1962425165
Provider Name (Legal Business Name): FERNANDO A RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 WEBB ROAD SUITE 311
TAMPA FL
33615
US

IV. Provider business mailing address

6101 WEBB ROAD SUITE 311
TAMPA FL
33615
US

V. Phone/Fax

Practice location:
  • Phone: 813-886-7112
  • Fax: 813-882-4260
Mailing address:
  • Phone: 813-886-7112
  • Fax: 813-882-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME42229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: