Provider Demographics
NPI:1558430884
Name:RODRIGUEZ, JESUS LUIS III (MD)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:LUIS
Last Name:RODRIGUEZ
Suffix:III
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 1:12602 TOEPPERWEIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3200
Mailing Address - Country:US
Mailing Address - Phone:210-599-6251
Mailing Address - Fax:210-599-6254
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3200
Practice Address - Country:US
Practice Address - Phone:210-599-6251
Practice Address - Fax:210-599-6254
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I15074Medicare UPIN
TX8C2036Medicare ID - Type Unspecified