Provider Demographics
NPI:1558587527
Name:RODRIGUEZ, LUIS ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E RIDGE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1536
Mailing Address - Country:US
Mailing Address - Phone:956-618-0404
Mailing Address - Fax:956-618-3177
Practice Address - Street 1:1400 E RIDGE RD STE 8
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1536
Practice Address - Country:US
Practice Address - Phone:956-618-0404
Practice Address - Fax:956-618-3177
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127109003Medicaid