Provider Demographics
NPI:1558342766
Name:RODRIGUEZ, GABRIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89836
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109-6836
Mailing Address - Country:US
Mailing Address - Phone:605-274-2564
Mailing Address - Fax:605-274-2562
Practice Address - Street 1:1320 S MINNESOTA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0656
Practice Address - Country:US
Practice Address - Phone:605-274-2564
Practice Address - Fax:605-274-2562
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD209213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00817UOtherGROUP MEDICARE NUMBER
TX140880903Medicaid
TX8D6552OtherBCBS
SD6832110001Medicare NSC
8D6552Medicare PIN
TX140880903Medicaid