Provider Demographics
NPI:1023005196
Name:RODRIGUEZ-REYES, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:RODRIGUEZ-REYES
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 1:1415 NORTH LOOP W
Mailing Address - Street 2:SUITE 820
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1664
Mailing Address - Country:US
Mailing Address - Phone:713-861-8200
Mailing Address - Fax:713-861-8261
Practice Address - Street 1:1415 NORTH LOOP W
Practice Address - Street 2:SUITE 820
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1664
Practice Address - Country:US
Practice Address - Phone:713-861-8200
Practice Address - Fax:713-861-8261
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL78662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163583102Medicaid
TX8D3493Medicare ID - Type Unspecified
TX8F6975Medicare PIN
I00147Medicare UPIN