Provider Demographics
NPI:1720010283
Name:CRES A RODRIGUEZ MD PA
Entity Type:Organization
Organization Name:CRES A RODRIGUEZ MD PA
Other - Org Name:ADULT & GERIATRIC MEDICAL CARE, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRES
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-915-5555
Mailing Address - Street 1:7001 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3910
Mailing Address - Country:US
Mailing Address - Phone:813-915-5555
Mailing Address - Fax:813-931-7508
Practice Address - Street 1:7001 N DALE MABRY HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-915-5555
Practice Address - Fax:813-931-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51442207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047016300Medicaid
FL047016300Medicaid
E19677Medicare UPIN