Provider Demographics
NPI:1720084445
Name:RODWICK, BARRY M (M D)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:RODWICK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2349 SUNSET POINT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1456
Mailing Address - Country:US
Mailing Address - Phone:727-216-6193
Mailing Address - Fax:727-216-4992
Practice Address - Street 1:2349 SUNSET POINT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1456
Practice Address - Country:US
Practice Address - Phone:727-216-6193
Practice Address - Fax:727-216-4992
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063224400Medicaid
FL666778OtherAETNA
FLE34048Medicare UPIN
FL666778OtherAETNA