Basic Information
| Provider Information | |||||||||
| NPI: | 1336629104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J W RODRIGUEZ MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 W DE LEON ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138782229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2835 W DE LEON ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138782229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8136014242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME55881 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.