Provider Demographics
NPI:1053300590
Name:RODRIGUEZ, ANTONIO L (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:L
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 1:515 WEST STATE RD. 434
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5162
Mailing Address - Country:US
Mailing Address - Phone:407-265-7775
Mailing Address - Fax:407-265-2266
Practice Address - Street 1:515 WEST STATE RD. 434
Practice Address - Street 2:SUITE 203
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5162
Practice Address - Country:US
Practice Address - Phone:407-265-7775
Practice Address - Fax:407-265-2266
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61778207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250303400Medicaid
FL28356YMedicare PIN
FL28356AMedicare PIN
FL250303400Medicaid