Provider Demographics
NPI:1629057914
Name:RODRIGUEZ, PAUL A (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 NE 25TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-941-0484
Mailing Address - Fax:954-941-0485
Practice Address - Street 1:1821 NE 25TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-941-0484
Practice Address - Fax:954-941-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7048207L00000X, 208VP0000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL285366OtherAVMED
FL257541800Medicaid
FL050072248OtherRAILROAD MEDICARE
FL49427OtherBLUE CROSS BLUE SHIELD
FL49427OtherBCBS OF FLORIDA
FLL4QH7OtherFLORIDA BLUE
FL49427OtherBLUE CROSS BLUE SHIELD
FLH04349Medicare UPIN