Provider Demographics
NPI:1306848213
Name:RODRIGUEZ, OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSVALDO
Other - Middle Name:
Other - Last Name:RODRIGUEZ-ROSADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2504 MILLER WOODS CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3819
Mailing Address - Country:US
Mailing Address - Phone:813-655-1545
Mailing Address - Fax:813-514-0337
Practice Address - Street 1:2504 MILLER WOODS CT
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3819
Practice Address - Country:US
Practice Address - Phone:813-655-1545
Practice Address - Fax:813-514-0337
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57780207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE74793Medicare UPIN
FL262377300Medicaid
FL11763Medicare ID - Type Unspecified