Basic Information
| Provider Information | |||||||||
| NPI: | 1295061570 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSE W RODRIGUEZ MD PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 W SWANN AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138782229 | ||||||||
| FaxNumber: | 8138771277 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 W SWANN AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138782229 | ||||||||
| FaxNumber: | 8138771277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2009 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8138782229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME55881 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.