Provider Demographics
NPI:1285628537
Name:MORENO GARCIA, RODRIGO (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:MORENO GARCIA
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-561-4263
Practice Address - Fax:502-561-4221
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38401207XS0106X
IN01058351A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64093230Medicaid
IN200502120AMedicaid
KY64093230Medicaid
INP00115882Medicare PIN
IN218440NMedicare ID - Type Unspecified
KY64093230Medicaid