Provider Demographics
NPI:1003893793
Name:RODRIGUE, RENAUD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RENAUD
Middle Name:P
Last Name:RODRIGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:BLDG III, SUITE 320
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-265-9991
Mailing Address - Fax:
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:BLDG III, SUITE 320
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-265-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4214207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0094YBOtherBCBS
TXTXB160644Medicare PIN
F38849Medicare UPIN
TX83916KOtherBCBS
TX050065970OtherRAIL ROAD
TX125328805Medicaid
TX125328802Medicaid
TX89230KMedicare PIN
TX125328804Medicaid
TX89014KMedicare PIN