Provider Demographics
NPI:1376503078
Name:RODRIGUEZ, JOSE RAUL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE RAUL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J. RAUL
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23 TERRAVALE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3504
Mailing Address - Country:US
Mailing Address - Phone:956-459-7027
Mailing Address - Fax:
Practice Address - Street 1:23 TERRAVALE CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-3504
Practice Address - Country:US
Practice Address - Phone:956-459-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0278208600000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N027OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX120451305Medicaid
TX020045338OtherMEDICARE RAILROAD
TX614111Medicare PIN
TXD67659Medicare UPIN