Healthcare Provider Details

I. General information

NPI: 1982702759
Provider Name (Legal Business Name): BRANDON RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43309 US HWY 19 N ST LUKE'S CATARACT & LASER INSTITUTE
TARPON SPRINGS FL
34689
US

IV. Provider business mailing address

43309 US HWY 19 N ST LUKE'S CATARACT & LASER INSTITUTE
TARPON SPRINGS FL
34689
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-2020
  • Fax:
Mailing address:
  • Phone: 727-938-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 109827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: