Provider Demographics
NPI:1427231034
Name:JOHN D. RODRIGUEZ, M.D., P.A.
Entity Type:Organization
Organization Name:JOHN D. RODRIGUEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-490-5080
Mailing Address - Street 1:540 OAK CENTRE DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3936
Mailing Address - Country:US
Mailing Address - Phone:210-490-5080
Mailing Address - Fax:210-490-5889
Practice Address - Street 1:540 OAK CENTRE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3936
Practice Address - Country:US
Practice Address - Phone:210-490-5080
Practice Address - Fax:210-490-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176365801Medicaid
TX45D1045710OtherCLIA
TXG28486Medicare UPIN
TX176365801Medicaid