| Rdm Professional Services, Inc. | |
|
437 Sw Rosemary Dr Lake City FL 32024-6715 | |
| (973) 610-6389 | |
| (386) 935-4331 |
| Full Name | Rdm Professional Services, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 437 Sw Rosemary Dr, Lake City, Florida |
| Authorized Official Name and Position | Rolando Dominguez Mustafa (OWNER / MEDICAL DIRECTOR) |
| Authorized Official Contact | 9736106389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rdm Professional Services, Inc. 437 Sw Rosemary Dr Lake City FL 32024-6715 Ph: (973) 610-6389 | Rdm Professional Services, Inc. 437 Sw Rosemary Dr Lake City FL 32024-6715 Ph: (973) 610-6389 |
| NPI Number | 1699322867 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 08/22/2019 |
| Medicare PECOS PAC ID | 8820423502 |
|---|---|
| Medicare Enrollment ID | O20200128000568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699322867 | NPI | - | NPPES |
| 015321200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RA0000X | Internal Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
| Provider Name | Rolando Dominguez Mustafa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1508145251 PECOS PAC ID: 0143472225 Enrollment ID: I20150916002917 |
| Provider Name | David C Terrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811411754 PECOS PAC ID: 9436416849 Enrollment ID: I20171120001330 |
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