Provider Demographics
NPI:1417903220
Name:RODRIGUEZ, SEGUNDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:SEGUNDO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEGUNDO
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:611 CALLE PAVIA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2239
Mailing Address - Country:US
Mailing Address - Phone:787-727-4737
Mailing Address - Fax:787-727-4714
Practice Address - Street 1:611 CALLE PAVIA
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-727-4737
Practice Address - Fax:787-727-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011740208C00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37205Medicare UPIN