Provider Demographics
NPI:1639194087
Name:RODRIGUEZ, JOSE W (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:W
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 1:2835 W DE LEON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-878-2229
Mailing Address - Fax:866-651-8413
Practice Address - Street 1:2835 W DE LEON ST STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-878-2229
Practice Address - Fax:866-651-8413
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55881207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14854OtherBLUE CROSS
FL1639194087OtherNPI