Provider Demographics
NPI:1558314468
Name:SIDRON, RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:SIDRON
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 1:8410 W FLAGLER ST STE 212-213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:786-388-9877
Mailing Address - Fax:786-388-9627
Practice Address - Street 1:8410 W FLAGLER ST STE 212-213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:786-388-9877
Practice Address - Fax:786-388-9627
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-09-20
Deactivation Date:2006-07-17
Deactivation Code:
Reactivation Date:2006-10-11
Provider Licenses
StateLicense IDTaxonomies
FLMD87379208000000X
FLME87379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267832200Medicaid