Basic Information
| Provider Information | |||||||||
| NPI: | 1871608885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | REY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: MANAGED CARE DEPT. | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 7340 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852517216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809456896 | ||||||||
| FaxNumber: | 4809457287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 43820 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 99S006800014 | 01 | AZ | MEDISUN ONE | OTHER | P00900578 | 01 | AZ | RAILROAD MEDICARE | OTHER | 6484497 | 01 | AZ | CIGNA | OTHER | 590059 | 05 | AZ | MEDICAID | 743205 | 01 | AZ | ARIZONA FOUNDATION CATHOLIC HC | OTHER | 3Z4670 | 01 | AZ | HEALTH NET | OTHER | 5970209 | 01 | AZ | AETNA | OTHER |