Provider Demographics
NPI:1760630891
Name:RODRIGUEZ, RAMON ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:18590 NW 67TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:786-454-9850
Practice Address - Fax:305-818-7405
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121893208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003084200Medicaid
FL003084200Medicaid