Provider Demographics
NPI:1649272055
Name:RODRIGUEZ, JULIO L (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:L
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:4881 PALM BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-3217
Practice Address - Country:US
Practice Address - Phone:239-693-9191
Practice Address - Fax:239-693-7369
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2023-12-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-13
Provider Licenses
StateLicense IDTaxonomies
FLME0059828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine