Provider Demographics
NPI:1942293972
Name:RODRIGUEZ, ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
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 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-539-0469
Practice Address - Street 1:766 N SUN DR
Practice Address - Street 2:SUITE 3030
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2552
Practice Address - Country:US
Practice Address - Phone:407-444-2800
Practice Address - Fax:407-444-2810
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0061653207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26905OtherBCBS
FL209729OtherAVMED
FL390003851OtherRAILROAD MEDICARE
FL377384100Medicaid
FL26905OtherBCBS
FLG01071Medicare UPIN
FL591561574OtherEIN