Provider Demographics
NPI:1396797692
Name:RODRIGUES, GOTARDO ALENCAR (MD)
Entity type:Individual
Prefix:DR
First Name:GOTARDO
Middle Name:ALENCAR
Last Name:RODRIGUES
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:78 SW 13TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2479
Practice Address - Country:US
Practice Address - Phone:305-642-6966
Practice Address - Fax:305-642-6965
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069345207RH0003X
FLME69345207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01594401OtherRR MEDICARE
FLP971527OtherOPTIMUM
FL214615OtherAVMED
FL32838OtherBCBS
FL14428OtherDIMENSION HEALTH
FLP1035761OtherFREEDOM
FL251480000Medicaid
FL4079983OtherCIGNA
FL268089100Medicaid
FL278877OtherAVMED
FL7509277OtherAETNA
FL7509277OtherAETNA
FL32838ZMedicare PIN
FLQ0473Medicare PIN