Provider Demographics
NPI:1861410060
Name:RODRIGUEZ, RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:RODRIGUEZ
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 1:10051 5TH STREET NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:954-656-8855
Mailing Address - Fax:954-656-8856
Practice Address - Street 1:2825 NORTH STATE ROAD 7
Practice Address - Street 2:SUITE 204
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-935-1477
Practice Address - Fax:954-656-8856
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67577207R00000X
FLME0067577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27657YMedicare ID - Type Unspecified