Provider Demographics
NPI:1164593505
Name:RODRIGUEZ, ALFREDO DM (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:DM
Last Name:RODRIGUEZ
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 1:2540 N GALLOWAY AVE
Mailing Address - Street 2:SUTIE # 301
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6306
Mailing Address - Country:US
Mailing Address - Phone:972-270-7585
Mailing Address - Fax:972-613-3334
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:SUTIE # 301
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6306
Practice Address - Country:US
Practice Address - Phone:972-270-7585
Practice Address - Fax:972-613-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDF3594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HK67OtherPROVIDER NUMBER BCBS
TX00HK67OtherPROVIDER NUMBER BCBS
TXC21192Medicare UPIN