Provider Demographics
NPI:1821059312
Name:RODRIGUEZ FUNDORA, WILLIAM (DO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:RODRIGUEZ FUNDORA
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 1:1100 SW 57 AVE #101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-644-1550
Mailing Address - Fax:305-269-1068
Practice Address - Street 1:1100 SW 57 AVE #101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-644-1550
Practice Address - Fax:305-269-1068
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007275207Q00000X
FLOS-0007275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260231800Medicaid
G82410Medicare UPIN
FLG82410Medicare UPIN
FLE14512Medicare ID - Type Unspecified