Provider Demographics
NPI:1902936016
Name:BANEGAS, RODRIGO (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:BANEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 S SEACREST BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7944
Mailing Address - Country:US
Mailing Address - Phone:561-620-1653
Mailing Address - Fax:561-742-3583
Practice Address - Street 1:2828 S SEACREST BLVD STE 216
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7944
Practice Address - Country:US
Practice Address - Phone:561-620-1653
Practice Address - Fax:561-742-3583
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142621207XS0106X
KY41844208600000X, 208600000X
KYFT398390200000X
IN11013081A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0988914Medicare PIN