Provider Demographics
NPI:1952444648
Name:RODRIGUEZ, JORGE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
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 1:14310 N DALE MABRY HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2059
Mailing Address - Country:US
Mailing Address - Phone:813-615-7028
Mailing Address - Fax:813-615-8008
Practice Address - Street 1:14310 N DALE MABRY HWY STE 305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2059
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018452700Medicaid
FLIS187YMedicare PIN