Provider Demographics
NPI:1376733683
Name:RODOLFO L DY MD PA
Entity Type:Organization
Organization Name:RODOLFO L DY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:LAUIGAN
Authorized Official - Last Name:DY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-863-0034
Mailing Address - Street 1:14100 FIVAY ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7159
Mailing Address - Country:US
Mailing Address - Phone:727-863-0034
Mailing Address - Fax:727-869-9465
Practice Address - Street 1:14100 FIVAY ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7159
Practice Address - Country:US
Practice Address - Phone:727-863-0034
Practice Address - Fax:727-869-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME004985208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1450OtherMEDICARE GROUP NUMBER
FLD61040Medicare UPIN