Provider Demographics
NPI:1376795955
Name:OVIEDO, RODOLFO JOSE (MD, FACS, FASMBS)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:JOSE
Last Name:OVIEDO
Suffix:
Gender:M
Credentials:MD, FACS, FASMBS
Other - Prefix:
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Mailing Address - Street 1:4848 NE STALLINGS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4848 NE STALLINGS DR STE 102
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1256
Practice Address - Country:US
Practice Address - Phone:936-569-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8318208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery