Provider Demographics
NPI:1336107614
Name:RODRIGUEZ, DIRK I (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:I
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 1:9080 HARRY HINES BLVD
Mailing Address - Street 2:211
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1720
Mailing Address - Country:US
Mailing Address - Phone:214-373-4751
Mailing Address - Fax:214-637-0886
Practice Address - Street 1:9080 HARRY HINES BLVD
Practice Address - Street 2:211
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1720
Practice Address - Country:US
Practice Address - Phone:214-373-4751
Practice Address - Fax:214-637-0886
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00585WOtherBC/BS OF TEXAS
8F23556Medicare PIN
00585WOtherBC/BS OF TEXAS