Provider Demographics
NPI:1851672620
Name:RODRIGUEZ, SAUL AHMED (MD)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:AHMED
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:P.O. BOX 9733
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32417
Mailing Address - Country:US
Mailing Address - Phone:786-972-0579
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:280 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4919
Practice Address - Country:US
Practice Address - Phone:850-215-3932
Practice Address - Fax:850-215-3959
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009690500Medicaid