Provider Demographics
NPI:1477559292
Name:RODRIGUEZ, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2176
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-2176
Mailing Address - Country:US
Mailing Address - Phone:402-463-0404
Mailing Address - Fax:402-462-5057
Practice Address - Street 1:715 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4451
Practice Address - Country:US
Practice Address - Phone:402-461-5191
Practice Address - Fax:402-461-5088
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE203982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101346OtherBCBS KANSAS
H00776OtherSTERLING OPTION ONE
KSCHILDRENS MERCYMedicaid
68901B012OtherTRICARE
NE06118OtherBCBS OF NEBRASKA
NE9641OtherMIDLANDS CHOICE
NEH007776OtherCOVENTRY HEALTH NE
NE271961Medicare PIN
NE06118OtherBCBS OF NEBRASKA
KSCHILDRENS MERCYMedicaid