Provider Demographics
NPI:1144249954
Name:RODRIGUEZ, MARIE (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9753 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:STE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7841
Mailing Address - Country:US
Mailing Address - Phone:407-412-5985
Mailing Address - Fax:407-412-5987
Practice Address - Street 1:931 W OAK ST
Practice Address - Street 2:STE 103
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4973
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-962-4446
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME77642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00669495OtherRR MEDICARE
FL271508200Medicaid
FLP00669495OtherRR MEDICARE
FL271508200Medicaid