MEDICARE: JEEVAN DIPTEE RODRIGUES 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	2084P0800X	Psychiatry Physician	ME89856	FL

General Provider Information

NPI Number	:	1912106337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEEVAN DIPTEE RODRIGUES MD PA

Provider Business Mailing Address
First Line	:	810 116TH AVE
Second Line	:
City	:	TREASURE ISLAND
State	:	FL
Zip	:	33706-1017
Country	:	US
Telephone Number	:	727-743-9158
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 116TH AVE
Second Line	:
City	:	TREASURE ISLAND
State	:	FL
Zip	:	33706-1017
Country	:	US
Telephone Number	:	727-743-9158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEEVAN DIPTEE RODRIGUES
Credential	:	MD
Telephone Number	:	727-743-9158

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	04/20/2008

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