Provider Demographics
NPI:1508963802
Name:RODRIGUEZ, MARTHA MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MERCEDES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 OCEAN DR
Mailing Address - Street 2:STE #11
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5802
Mailing Address - Country:US
Mailing Address - Phone:561-364-8056
Mailing Address - Fax:561-364-8507
Practice Address - Street 1:2015 OCEAN DR
Practice Address - Street 2:STE #11
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5802
Practice Address - Country:US
Practice Address - Phone:561-364-8056
Practice Address - Fax:561-364-8507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF96629Medicare UPIN