Provider Demographics
NPI:1093754848
Name:RODRIGUEZ, FREDDIE MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:MIGUEL
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-2052
Mailing Address - Fax:239-343-5348
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-2052
Practice Address - Fax:239-343-5348
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43498208M00000X
FLME0043498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068343400Medicaid
FL5390561OtherAETNA
FL3910354OtherCIGNA
FL025812OtherNHP
FL22366OtherSTAYWELL
FL100012OtherAVMED
FL96399OtherBLUE CROSS & BLUE SHIELD
FL000107002OtherHUMANA
FL5390561OtherAETNA
FLC67059Medicare UPIN