Provider Demographics
NPI:1447383187
Name:RODRIGUEZ, JESUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9179 GRISSOM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2803
Mailing Address - Country:US
Mailing Address - Phone:210-680-8081
Mailing Address - Fax:210-680-3133
Practice Address - Street 1:9179 GRISSOM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2803
Practice Address - Country:US
Practice Address - Phone:210-680-8081
Practice Address - Fax:210-680-3133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM8960OtherTEXAS LICENSE