Provider Demographics
NPI:1013941848
Name:RODRIGUEZ, SERGIO MAX JR (MD)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:MAX
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:777 E 25 ST
Mailing Address - Street 2:STE 210
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-691-3505
Mailing Address - Fax:305-691-4104
Practice Address - Street 1:777 E 25 ST
Practice Address - Street 2:STE 210
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-691-3505
Practice Address - Fax:305-691-4104
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0058313207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059599300Medicaid
FL12479Medicare ID - Type Unspecified
E89319Medicare UPIN