Provider Demographics
NPI:1942264957
Name:RODRIGUEZ, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
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 1:210 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4491
Mailing Address - Country:US
Mailing Address - Phone:407-215-0400
Mailing Address - Fax:407-215-0402
Practice Address - Street 1:210 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4491
Practice Address - Country:US
Practice Address - Phone:407-215-0400
Practice Address - Fax:407-215-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055953900Medicaid
1206414OtherUNITED HEALTHCARE MEDICAID
FLME0060714OtherLICENSE
FL298310OtherAVMED
4400683017OtherCIGNA
937409OtherUNITED HEALTHCARE
14420OtherBLUE CROSS BLUE SHIELD
FL204965420OtherUNITED HEALTHCARE
FL4369420OtherAETNA
FL4369420OtherAETNA
FL055953900Medicaid