Provider Demographics
NPI:1508917733
Name:RODRIGUEZ, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
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 1:3800 S.W 128 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2819
Mailing Address - Country:US
Mailing Address - Phone:954-438-7877
Mailing Address - Fax:954-442-4449
Practice Address - Street 1:3800 S.W. 128 AVENUE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2819
Practice Address - Country:US
Practice Address - Phone:954-438-7877
Practice Address - Fax:954-442-4449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14834OtherBLUE CROSS OF FLORIDA
FL251725600Medicaid
FLFLME0061780OtherFLORIDA LICENSE #
FLFLME0061780OtherFLORIDA LICENSE #
FL14834BMedicare ID - Type UnspecifiedMEDICARE #