Provider Demographics
NPI:1861489726
Name:RODRIGUEZ DE LA TORRE, JESUS RAMON (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:RAMON
Last Name:RODRIGUEZ DE LA TORRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:R
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7801 SW 24TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6538
Mailing Address - Country:US
Mailing Address - Phone:305-534-9009
Mailing Address - Fax:305-907-5919
Practice Address - Street 1:7801 SW 24TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6538
Practice Address - Country:US
Practice Address - Phone:305-534-9009
Practice Address - Fax:305-907-5919
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048486500Medicaid
FL048486500Medicaid
FLE59884Medicare UPIN