MEDICARE: CRES A 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME51442	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	:	1720010283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRES A RODRIGUEZ MD PA

Provider Business Mailing Address
First Line	:	7001 N DALE MABRY HWY
Second Line	:	SUITE 11
City	:	TAMPA
State	:	FL
Zip	:	33614-3910
Country	:	US
Telephone Number	:	813-915-5555
Fax Number	:	813-931-7508

Provider Business Practice Location Address
First Line	:	7001 N DALE MABRY HWY
Second Line	:	SUITE 11
City	:	TAMPA
State	:	FL
Zip	:	33614-3910
Country	:	US
Telephone Number	:	813-915-5555
Fax Number	:	813-931-7508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRES ANTONIO RODRIGUEZ
Credential	:	M.D.
Telephone Number	:	813-915-5555

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/03/2011

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