Provider Demographics
NPI:1952532046
Name:RODRIGUEZ, WILBERT DESS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:DESS
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 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:810 N NOWELL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7539
Practice Address - Country:US
Practice Address - Phone:407-290-9556
Practice Address - Fax:407-290-9509
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17652208D00000X
FLACN773208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17652OtherCOLEGIO DE MEDICOS CIRUJANOS
PRDM-17524-0OtherASSMCA
PR17652OtherMEDICAL LICENSE
PR79858OtherREGISTRO JUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA DE PR
FLACN773OtherMEDICAL LICENSE
FLFR1746520OtherDEA