Provider Demographics
NPI:1578511093
Name:RODRIGUEZ, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
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 1:3401 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4238
Mailing Address - Country:US
Mailing Address - Phone:305-294-8334
Mailing Address - Fax:215-248-1876
Practice Address - Street 1:3401 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4238
Practice Address - Country:US
Practice Address - Phone:305-294-8334
Practice Address - Fax:305-294-8340
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0311851E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12885890101Medicaid
PA12885890101Medicaid
PA171872Medicare PIN