Provider Demographics
NPI:1417361148
Name:GIRALT RODRIGUEZ, NADYN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NADYN
Middle Name:MICHELLE
Last Name:GIRALT RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17921 GORDONS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:ARP
Mailing Address - State:TX
Mailing Address - Zip Code:75750-4643
Mailing Address - Country:US
Mailing Address - Phone:817-729-2271
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-606-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR0720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty