Provider Demographics
NPI:1215013388
Name:RODRIGUEZ, GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
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:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-1221
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-615-7170
Practice Address - Street 1:16088 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2249
Practice Address - Country:US
Practice Address - Phone:713-637-1146
Practice Address - Fax:281-298-5311
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5018207P00000X
TXM9619207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199581301Medicaid
TX8BW919OtherBCBSTX
TX8L7135Medicare PIN