Provider Demographics
NPI:1801866603
Name:RODRIGUEZ, JAIME J (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:J
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:PO BOX 817087
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-1087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2235 N COMMERCE PKWY
Practice Address - Street 2:BLDG 5, # 2
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3251
Practice Address - Country:US
Practice Address - Phone:954-389-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58774207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12491OtherBCBS
A98501Medicare UPIN
FL12491ZMedicare PIN
FL12491OtherBCBS