Provider Demographics
NPI:1477680080
Name:RODRIGUEZ, RAUL MARCELO (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:MARCELO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 EDWARD CONRAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5092
Mailing Address - Country:US
Mailing Address - Phone:361-906-1554
Mailing Address - Fax:
Practice Address - Street 1:12023 EDWARD CONRAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5092
Practice Address - Country:US
Practice Address - Phone:361-906-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6867208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE42278Medicare UPIN