Provider Demographics
NPI:1588676480
Name:RODRIGUEZ, IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:IGNACIO
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 1:2234 QUAIL ROOST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327
Mailing Address - Country:US
Mailing Address - Phone:954-682-5171
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:2234 QUAIL ROOST DRIVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327
Practice Address - Country:US
Practice Address - Phone:954-682-5171
Practice Address - Fax:786-907-4485
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-02-05
Deactivation Date:2007-10-04
Deactivation Code:
Reactivation Date:2008-01-14
Provider Licenses
StateLicense IDTaxonomies
FLME42334207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372026800Medicaid
FL372026800Medicaid
FL02413ZMedicare PIN