Provider Demographics
NPI:1114252764
Name:VICTOR M. RODRIGUEZ, M.D., MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:VICTOR M. RODRIGUEZ, M.D., MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-664-1918
Mailing Address - Street 1:42 LAKE MIST DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5860
Mailing Address - Country:US
Mailing Address - Phone:713-664-1918
Mailing Address - Fax:713-664-2313
Practice Address - Street 1:4126 SOUTHWEST FWY
Practice Address - Street 2:SUITE 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7310
Practice Address - Country:US
Practice Address - Phone:713-664-1918
Practice Address - Fax:713-664-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD39093OtherUPIN
TX0039BSOtherMEDICARE
TX096596402Medicaid
TX8X2000OtherBLUE CROSS / BLUE SHIELD