Provider Demographics
NPI:1093819740
Name:MARIANO, RODRIGO ALBA (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:ALBA
Last Name:MARIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:310 NW MORFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6333
Mailing Address - Country:US
Mailing Address - Phone:580-595-4800
Mailing Address - Fax:580-595-4800
Practice Address - Street 1:4301 MOW WAY RD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2246
Practice Address - Fax:580-458-3433
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK20512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine