Provider Demographics
NPI:1992753628
Name:RODRIGUEZ, RENE JOSE (MD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5555 ANGLERS AVENUE
Mailing Address - Street 2:SUITE 24 FLORIDA UNITED RADIOLOGY
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312
Mailing Address - Country:US
Mailing Address - Phone:954-962-6265
Mailing Address - Fax:954-893-9595
Practice Address - Street 1:8201 W BROWARD BOULEVARD
Practice Address - Street 2:WESTSIDE REGIONAL MEDICAL CENTER
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-916-5448
Practice Address - Fax:954-476-3983
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLME229412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3861033Medicaid
FL3861033Medicaid
FL79378Medicare ID - Type Unspecified