Provider Demographics
NPI:1023031218
Name:RODRIGUEZ, ELEAZAR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ELEAZAR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-2508
Mailing Address - Country:US
Mailing Address - Phone:956-689-2493
Mailing Address - Fax:956-689-5090
Practice Address - Street 1:525 S 10TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-2508
Practice Address - Country:US
Practice Address - Phone:956-689-2493
Practice Address - Fax:956-689-5090
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03117OtherSTATE LICENSE
TXPA03117OtherSTATE LICENSE