Provider Demographics
NPI:1962466730
Name:NAZARIO, RHODERICK C (MD)
Entity Type:Individual
Prefix:DR
First Name:RHODERICK
Middle Name:C
Last Name:NAZARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1121 N CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4405
Mailing Address - Country:US
Mailing Address - Phone:407-933-1221
Mailing Address - Fax:407-933-0747
Practice Address - Street 1:1121 N CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-933-1221
Practice Address - Fax:407-933-0747
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL84666207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264756700Medicaid
FL3892967004OtherCIGNA PROVIDER ID
FL285149OtherAVMED PROVIDER ID
FL4800614OtherUHC PROVIDER ID
FL7728680OtherAETNA PROVIDER ID
FL17116OtherBLUE CROSS BLUE SHIELD
FL7728680OtherAETNA PROVIDER ID
FLH69834Medicare UPIN