Provider Demographics
NPI:1225080104
Name:RODRIGUEZ, HECTOR Y (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:Y
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HECTOR
Other - Middle Name:YAMIL
Other - Last Name:RODRIGUEZ-JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050645208800000X
OH35.127297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151370Medicaid
OH0151370Medicaid