Provider Demographics
NPI:1245420017
Name:RODRIGUEZ, PHILLIP ANTHONY
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL BRANCH HEALTH CLINIC INGLESIDE
Mailing Address - Street 2:327 CORAL SEA DRIVE, SUITE 165
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-5025
Mailing Address - Country:US
Mailing Address - Phone:361-776-4073
Mailing Address - Fax:361-776-1103
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC INGLESIDE
Practice Address - Street 2:327 CORAL SEA DRIVE, SUITE 165
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5025
Practice Address - Country:US
Practice Address - Phone:361-776-4073
Practice Address - Fax:361-776-1103
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman