Provider Demographics
NPI:1609879360
Name:RODAS, LUIS G (PA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:G
Last Name:RODAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NE 20TH AVE
Mailing Address - Street 2:APT # 301
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-6114
Mailing Address - Country:US
Mailing Address - Phone:954-429-1303
Mailing Address - Fax:954-337-0157
Practice Address - Street 1:4001 N OCEAN DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5968
Practice Address - Country:US
Practice Address - Phone:954-771-4000
Practice Address - Fax:954-776-0670
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100841363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100841OtherPHYSICIAN ASSISTANT LIC.