Provider Demographics
NPI:1497791651
Name:RODRIGUEZ-FAZZI, GERSON LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSON
Middle Name:LUIS
Last Name:RODRIGUEZ-FAZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERSON
Other - Middle Name:LUIS
Other - Last Name:RODRIGUEZ-FAZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-8480
Mailing Address - Fax:727-767-8420
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:5TH FLOOR DEPT 6941
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-767-8480
Practice Address - Fax:727-767-8420
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78038207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256269300Medicaid
FL46484YMedicare ID - Type Unspecified
FL256269300Medicaid