Provider Demographics
NPI:1467872143
Name:RODRIGUEZ, JEFFREY MAGUIRE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MAGUIRE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:MICHAEL
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-367-3360
Mailing Address - Fax:
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-367-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60207Q00000X
KYTP909207Q00000X
AZ007390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine