Provider Demographics
NPI:1316040710
Name:RODRIGUEZ, SERGIO MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:MAX
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7500 SW 8TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4400
Mailing Address - Country:US
Mailing Address - Phone:305-266-3306
Mailing Address - Fax:305-264-9426
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:305-266-3306
Practice Address - Fax:305-264-9426
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME14127208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047036800Medicaid
FL90099Medicare ID - Type Unspecified
FL047036800Medicaid