Provider Demographics
NPI:1467144196
Name:VINCENT, RODNEY DOUGLAS
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:DOUGLAS
Last Name:VINCENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 INDIAN ROCKS RD FL US
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1656
Mailing Address - Country:US
Mailing Address - Phone:772-429-7354
Mailing Address - Fax:
Practice Address - Street 1:1702 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1656
Practice Address - Country:US
Practice Address - Phone:172-764-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment