Provider Demographics
NPI:1841214996
Name:RODRIGUEZ, JESUS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MANUEL
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 1:9605 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2014
Mailing Address - Country:US
Mailing Address - Phone:305-559-0278
Mailing Address - Fax:305-559-3608
Practice Address - Street 1:9605 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:305-559-0278
Practice Address - Fax:305-559-3608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN516208D00000X
PR14396208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCJ946AMedicare PIN
PRI02090Medicare UPIN