Provider Demographics
NPI:1184697781
Name:RODRIGUEZ, LUIS RAMON (MD)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:RAMON
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2484 CARING WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-625-1999
Mailing Address - Fax:941-625-4600
Practice Address - Street 1:2484 CARING WAY
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-625-1999
Practice Address - Fax:941-625-4600
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-03-30
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Provider Licenses
StateLicense IDTaxonomies
FLME62983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372194900Medicaid