Provider Demographics
NPI:1912094822
Name:DANIEL, RODNEY S (MD MSCR)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:S
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4168 WOODLANDS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3496
Mailing Address - Country:US
Mailing Address - Phone:727-734-6631
Mailing Address - Fax:727-227-7204
Practice Address - Street 1:106 STATE ST E
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3651
Practice Address - Country:US
Practice Address - Phone:727-263-0800
Practice Address - Fax:813-852-0211
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108707207RR0500X, 207RR0500X
SC28661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7471952OtherAETNA
FL14C6BOtherBCBS
FL3782499OtherCIGNA
FL011168200Medicaid
FL3782499OtherCIGNA
FL7471952OtherAETNA
FL2780325OtherUNITED
FL2780325OtherUNITED
SCAA18208580Medicare PIN