Provider Demographics
NPI:1750371613
Name:RODMAN, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:RODMAN
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 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:929 S TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9239
Practice Address - Country:US
Practice Address - Phone:941-917-4700
Practice Address - Fax:941-917-4710
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73639208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252755300Medicaid
FL41522OtherBCBS
FL41522Medicare PIN
FL41522OtherBCBS