Provider Demographics
NPI:1447237292
Name:RODRIGUEZ-RODRIGUEZ, JUAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RODRIGUEZ-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 1:306 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4537
Mailing Address - Country:US
Mailing Address - Phone:407-343-2700
Mailing Address - Fax:407-343-4807
Practice Address - Street 1:306 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4537
Practice Address - Country:US
Practice Address - Phone:407-343-2700
Practice Address - Fax:407-343-4807
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94922207R00000X
TXK6271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG82110Medicare UPIN
FLAC016ZMedicare UPIN
TX82V539Medicare ID - Type Unspecified