Provider Demographics
NPI:1487748356
Name:NASSIF, RODERICK (DO)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:NASSIF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9279
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9279
Mailing Address - Country:US
Mailing Address - Phone:239-440-6456
Mailing Address - Fax:239-236-0337
Practice Address - Street 1:9371 CYPRESS LAKE DR STE 12
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4995
Practice Address - Country:US
Practice Address - Phone:239-440-6456
Practice Address - Fax:239-236-0337
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG54934Medicare UPIN