MEDICARE: PAUL A RODRIGUEZ DO 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	174400000X	Specialist	OS7048	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DQ2139	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	285366	OTHER	FL	AVMED
3	L4QH7	OTHER	FL	FLORIDA BLUE
4	49427	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881603900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL A RODRIGUEZ DO PA

Provider Business Mailing Address
First Line	:	1821 NE 25TH STREET
Second Line	:	SUITE 100
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064
Country	:	US
Telephone Number	:	954-941-0484
Fax Number	:	954-941-0485

Provider Business Practice Location Address
First Line	:	1821 NE 25TH ST
Second Line	:	SUITE 100
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7744
Country	:	US
Telephone Number	:	954-941-0484
Fax Number	:	954-941-0485

Authorized Official
Title or Position	:	DIRECTOR, PRESIDENT,SECRETARY,TREAS
Name	:	PAUL A RODRIGUEZ
Credential	:	D.O., P.A.
Telephone Number	:	954-941-0484

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	04/11/2017

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Directions to “PAUL A RODRIGUEZ DO PA ” Practice Location

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