Provider Demographics
NPI:1003937244
Name:RODRIGUEZ MOLINET, TOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:RODRIGUEZ MOLINET
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:PO BOX 945385
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 N STONE ST STE D
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0824
Practice Address - Country:US
Practice Address - Phone:386-822-9112
Practice Address - Fax:386-424-5249
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25049207RG0100X
NY234802207R00000X
TXS8378207RG0100X
FLME89177207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024066OtherMEDICAID
WVWV1851AOtherMEDICARE PTAN
WVP01178675OtherRR MEDICARE PTAN
WV25049OtherSTATE MEDICAL LICENSE