Provider Demographics
NPI:1154324366
Name:RODRIGUEZ, RAY JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:JAIME
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7731 OLD CANTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6115
Mailing Address - Country:US
Mailing Address - Phone:601-499-0935
Mailing Address - Fax:601-499-0936
Practice Address - Street 1:7730 OLD CANTON RD BLDG B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9299
Practice Address - Country:US
Practice Address - Phone:601-499-0935
Practice Address - Fax:601-499-0936
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS21881207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I036084Medicare PIN
MS302I039134Medicare PIN
PRH82876Medicare UPIN