Provider Demographics
NPI:1639143910
Name:DY, RODOLFO L (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:L
Last Name:DY
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 1698
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1698
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:6633 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-375-2849
Practice Address - Fax:727-838-6188
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049985208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00937056OtherMEDICARE RAILROAD PROVIDER NUMBER
FL003205900Medicaid
FL04220ZMedicare PIN
FLP00937056OtherMEDICARE RAILROAD PROVIDER NUMBER