Provider Demographics
NPI:1407013295
Name:FELIX-RODRIGUEZ, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:FELIX-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 TAVISTOCK LAKES BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7559
Mailing Address - Country:US
Mailing Address - Phone:407-930-7801
Mailing Address - Fax:407-930-7806
Practice Address - Street 1:9975 TAVISTOCK LAKES BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7559
Practice Address - Country:US
Practice Address - Phone:407-930-7801
Practice Address - Fax:407-930-7806
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107554207PS0010X, 207QS0010X
KS04-33108207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110990007OtherMEDICARE
KS200565650AMedicaid
KS200565650AMedicaid