Provider Demographics
NPI:1174503643
Name:RODRIGUES, LORI R (MD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:R
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3580 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4029
Mailing Address - Country:US
Mailing Address - Phone:561-425-5085
Mailing Address - Fax:561-429-5167
Practice Address - Street 1:3580 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4029
Practice Address - Country:US
Practice Address - Phone:561-425-5085
Practice Address - Fax:561-429-5167
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01018526Medicaid