Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME35594 | FL |
NPI | 1073598611 |
---|---|
Provider Name | Wayne D Rodriguez |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 31/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067516400 | (05) | FL |
390005081 | RR MEDICARE (01) | FL |
D51297 | (02) |