Provider Demographics
NPI:1770504565
Name:RODRIGUEZ GONZALEZ, LUIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:RODRIGUEZ GONZALEZ
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 1:2909 WINGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5036
Mailing Address - Country:US
Mailing Address - Phone:914-979-4269
Mailing Address - Fax:
Practice Address - Street 1:4597 CASABLANCA CIR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1206
Practice Address - Country:US
Practice Address - Phone:863-236-9550
Practice Address - Fax:877-832-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098164Medicare ID - Type UnspecifiedPROVIDER NUMBER