MEDICARE: JULIO L RODRIGUEZ MD PA

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	207Q00000X	Family Medicine Physician	ME59828	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	:	1396045266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIO L RODRIGUEZ MD PA

Provider Business Mailing Address
First Line	:	4881 PALM BEACH BLVD STE 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3217
Country	:	US
Telephone Number	:	239-693-9191
Fax Number	:	239-693-7369

Provider Business Practice Location Address
First Line	:	4881 PALM BEACH BLVD STE 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3217
Country	:	US
Telephone Number	:	239-693-9191
Fax Number	:	239-693-7369

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIO LAZARO RODRIGUEZ
Credential	:	MD
Telephone Number	:	239-693-9191

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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