MEDICARE: MID FLORIDA MEDICAL SPECIALIST

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	261QH0100X	Health Service Clinic/Center	ME57417	FL

General Provider Information

NPI Number	:	1235487133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID FLORIDA MEDICAL SPECIALIST

Provider Business Mailing Address
First Line	:	51 N DOVERPLUM AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-3308
Country	:	US
Telephone Number	:	407-583-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N DOVERPLUM AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-3308
Country	:	US
Telephone Number	:	407-583-7130
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VASCO A RODRIGUEZ
Credential	:	D.C.
Telephone Number	:	407-583-7130

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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Directions to “MID FLORIDA MEDICAL SPECIALIST ” Practice Location

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