MEDICARE: DR. JOHN C RODRIGUEZ MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME74600	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00318053	OTHER	FL	RR MEDICARE FRL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ME74600	OTHER	FL	FL WORK CERTIFICATION
4	110556	OTHER		AMERIGROUP
5	O1644	OTHER		BCBSFL
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1558315069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	8791 CONFERENCE DR
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5822
Country	:	US
Telephone Number	:	239-938-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 BARKLEY CIR
Second Line	:	STE. 100 & 101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4514
Country	:	US
Telephone Number	:	239-938-3500
Fax Number	:	239-278-0588

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/09/2014

63 BARKLEY CIR STE 104
FORT MYERS, FL
33907-4514

Practice Phone: 239-275-8452
Practice Fax: 239-274-3182