Provider Demographics
NPI:1629181326
Name:RODRIGUEZ, DAGOBERTO JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAGOBERTO
Middle Name:JESUS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:J
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2825 N STATE ROAD 7
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5737
Mailing Address - Country:US
Mailing Address - Phone:954-752-8799
Mailing Address - Fax:954-752-0509
Practice Address - Street 1:2825 N STATE ROAD 7
Practice Address - Street 2:SUITE 305
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-752-8799
Practice Address - Fax:954-752-0509
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME058463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME-58463OtherLIC# ME-58463
FL265743100Medicaid