Provider Demographics
NPI:1528404944
Name:RODRIGUEZ, SADRAC (MD)
Entity Type:Individual
Prefix:DR
First Name:SADRAC
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CHURCH ST
Mailing Address - Street 2:BOX 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37236-4400
Mailing Address - Country:US
Mailing Address - Phone:615-284-4672
Mailing Address - Fax:615-284-5752
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:BOX 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-4400
Practice Address - Country:US
Practice Address - Phone:615-284-4672
Practice Address - Fax:615-284-5752
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN54152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021710Medicaid