Provider Demographics
NPI:1437382389
Name:RODRIGUEZ, MARK ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name: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 1:2999 NE 191ST ST STE 600
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3385
Mailing Address - Country:US
Mailing Address - Phone:786-981-0640
Mailing Address - Fax:305-677-8067
Practice Address - Street 1:2999 NE 191ST ST STE 600
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3385
Practice Address - Country:US
Practice Address - Phone:786-981-0640
Practice Address - Fax:305-677-8067
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093049207R00000X
FLME1751142084P0800X
WAMD611567182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine