Healthcare Provider Details

I. General information

NPI: 1215966643
Provider Name (Legal Business Name): JOSE R RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 SW 144TH ST
VILLAGE OF PALMETTO BAY FL
33176-7296
US

IV. Provider business mailing address

8660 W FLAGLER ST SUITE 200
MIAMI FL
33144-2036
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-3884
  • Fax: 305-554-4833
Mailing address:
  • Phone: 305-227-3884
  • Fax: 305-554-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME59427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: