1962466730 NPI number — DR. RHODERICK C NAZARIO M.D.

Table of content: DR. RHODERICK C NAZARIO M.D. (NPI 1962466730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962466730 NPI number — DR. RHODERICK C NAZARIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZARIO
Provider First Name:
RHODERICK
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
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:
1962466730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 N CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-933-1221
Provider Business Mailing Address Fax Number:
407-933-0747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-933-1221
Provider Business Practice Location Address Fax Number:
407-933-0747
Provider Enumeration Date:
04/17/2006

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: 207RP1001X , with the licence number:  84666 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 84666 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 264756700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3892967004 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 285149 . This is a "AVMED PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4800614 . This is a "UHC PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7728680 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 17116 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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