MEDICARE: ANTONIO L. RODRIGUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME61778	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053300590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO L. RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	515 WEST STATE RD. 434
Second Line	:	SUITE 203
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-265-7775
Fax Number	:	407-265-2266

Provider Business Practice Location Address
First Line	:	515 WEST STATE RD. 434
Second Line	:	SUITE 203
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-265-7775
Fax Number	:	407-265-2266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	10/08/2014

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