Provider Demographics
NPI:1184739898
Name:RODRIGUEZ, ALBERT (MD)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
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 1:3353 W BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:813-908-5827
Mailing Address - Fax:813-908-6132
Practice Address - Street 1:3353 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-908-5827
Practice Address - Fax:813-908-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48061207R00000X
FLME 0048061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256223500Medicaid
FL593457500OtherALL OTHER INSURANCES
FL593457500OtherALL OTHER INSURANCES
FLP00084345Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL10866Medicare ID - Type Unspecified