Provider Demographics
NPI:1508921172
Name:RODRIGUEZ, EUGENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
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:PO BOX 9816
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-0816
Mailing Address - Country:US
Mailing Address - Phone:561-330-4695
Mailing Address - Fax:561-330-4696
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE E-2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-330-4695
Practice Address - Fax:561-330-4696
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061779208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF38697Medicare UPIN
FL370779200Medicaid
FL17944Medicare ID - Type UnspecifiedMEDICARE ID NUMBER