Provider Demographics
NPI: | 1164814034 |
---|---|
Name: | RODRIGUEZ, JIM (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JIM |
Middle Name: | |
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: | HC06 6249 |
Mailing Address - Street 2: | |
Mailing Address - City: | JUANA DIAZ |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00795 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-464-2872 |
Mailing Address - Fax: | |
Practice Address - Street 1: | HC06 6249 |
Practice Address - Street 2: | |
Practice Address - City: | JUANA DIAZ |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00795 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-464-2872 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2015-03-02 |
Last Update Date: | 2015-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 19914 | 207K00000X, 207L00000X, 207N00000X, 207P00000X, 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 208000000X, 208100000X, 208200000X, 2084B0040X, 208600000X, 208800000X, 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | |
No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology |