Provider Demographics
NPI:1174665202
Name:RODRIGUEZ RODRIGUEZ, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:RODRIGUEZ 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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0897
Mailing Address - Country:US
Mailing Address - Phone:787-878-2658
Mailing Address - Fax:787-879-9286
Practice Address - Street 1:AVENIDA JOSE DE DIEGO NUM 32 ALTOS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2658
Practice Address - Fax:787-879-9286
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023882Medicare PIN
PRE33084Medicare UPIN