1861400343 NPI number — MR. JEAN F RODNEY M.D.

Table of content: MR. JEAN F RODNEY M.D. (NPI 1861400343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861400343 NPI number — MR. JEAN F RODNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODNEY
Provider First Name:
JEAN
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861400343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6254 MIRAMAR PARKWAY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-273-9174
Provider Business Mailing Address Fax Number:
407-735-2101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 MIRAMAR PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
754-273-9174
Provider Business Practice Location Address Fax Number:
407-735-2101
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME84415 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: ME84415 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110412200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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