Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME0058313 | FL |
NPI | 1013941848 |
---|---|
Provider Name | Mr. Sergio Max Rodriguez JR. |
First Address | Hialeah, FL 33013 |
Second Address | Hialeah, FL 33013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059599300 | (05) | FL |
E89319 | (02) |