Provider Demographics
NPI:1508961558
Name:RODRIGUEZ NAZARIO, EDGAR ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ANTONIO
Last Name:RODRIGUEZ NAZARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0638
Mailing Address - Country:US
Mailing Address - Phone:787-823-5555
Mailing Address - Fax:787-823-2390
Practice Address - Street 1:28 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2127
Practice Address - Country:US
Practice Address - Phone:787-823-5555
Practice Address - Fax:787-823-2390
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH57821Medicare UPIN