MEDICARE: DR. RODOLFO L DY MD

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	208600000X	Surgery Physician	ME0049985	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00937056	OTHER	FL	MEDICARE RAILROAD PROVIDER NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1639143910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODOLFO L DY MD

Provider Business Mailing Address
First Line	:	PO BOX 1698
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-1698
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 FOREST AVE
Second Line	:	SUITE 100
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-2612
Country	:	US
Telephone Number	:	727-375-2849
Fax Number	:	727-838-6188

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/28/2011

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