Provider Demographics
NPI:1821290339
Name:DAVID RODRIGUEZ MD PA
Entity Type:Organization
Organization Name:DAVID RODRIGUEZ MD PA
Other - Org Name:DADELAND DERMATOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-670-0260
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:313
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7721
Mailing Address - Country:US
Mailing Address - Phone:305-670-0260
Mailing Address - Fax:305-670-2665
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:313
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7721
Practice Address - Country:US
Practice Address - Phone:305-670-0260
Practice Address - Fax:305-670-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052393300Medicaid
FL052393300Medicaid