Provider Demographics
NPI:1700468535
Name:LEON RODRIGUEZ, MICHAEL GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARDO
Last Name:LEON RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:21 S CHARLES RICHARD BEALL BLVD
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3332
Practice Address - Country:US
Practice Address - Phone:386-516-0930
Practice Address - Fax:386-668-6897
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR022654208D00000X
FLACN1439208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice