Provider Demographics
NPI:1275638447
Name:GRANADOS, RODOLFO V (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:V
Last Name:GRANADOS
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 8887
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8887
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2517
Practice Address - Street 1:2106 ELM VIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2772
Practice Address - Country:US
Practice Address - Phone:210-614-3371
Practice Address - Fax:210-614-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9494207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050004558OtherRAILROAD MEDICARE
TX126279203Medicaid
TX103525500OtherUSDOL
TX050004558OtherRAILROAD MEDICARE
TX00GR22Medicare ID - Type Unspecified