Provider Demographics
NPI:1225296080
Name:FERNANDO A RODRIGUEZ MD PA
Entity Type:Organization
Organization Name:FERNANDO A RODRIGUEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-886-7112
Mailing Address - Street 1:6101 WEBB ROAD SUITE #311
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-886-7112
Mailing Address - Fax:813-882-4260
Practice Address - Street 1:6101 WEBB ROAD SUITE #311
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-886-7112
Practice Address - Fax:813-882-4260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERNANDO A RODRIGUEZ MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42229207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036180100Medicaid
FL036180100Medicaid
FLD54043Medicare UPIN