Provider Demographics
NPI:1366444515
Name:RODRIGUEZ-FALCON, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:RODRIGUEZ-FALCON
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 1:2135 VALLEYGATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3751
Mailing Address - Country:US
Mailing Address - Phone:910-920-1858
Mailing Address - Fax:910-339-9040
Practice Address - Street 1:2135 VALLEYGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3751
Practice Address - Country:US
Practice Address - Phone:910-920-1858
Practice Address - Fax:910-339-9040
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400406207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137U3Medicaid
NC2032737Medicare ID - Type UnspecifiedPROVIDER NUMBER
NC89137U3Medicaid