Provider Demographics
NPI:1336117688
Name:RODRIGUEZ, RAMIRO (MD)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMIRO
Other - Middle Name:
Other - Last Name:RODRUIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1613 NORTH HARRISON PARKWAY
Mailing Address - Street 2:BLDG C-SUITE #200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2864
Mailing Address - Country:US
Mailing Address - Phone:954-838-2580
Mailing Address - Fax:
Practice Address - Street 1:7201 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2913
Practice Address - Country:US
Practice Address - Phone:954-724-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-12
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54337207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054545700Medicaid
FL054545700Medicaid
E90225Medicare UPIN
FL09787YMedicare ID - Type Unspecified
FL09787ZMedicare ID - Type Unspecified