Provider Demographics
NPI:1609091198
Name:RODRIGUEZ, FREDDY ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:ANGEL
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 1:3050 S 1ST ST STE 215
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3442
Mailing Address - Country:US
Mailing Address - Phone:972-926-1199
Mailing Address - Fax:972-278-6830
Practice Address - Street 1:3050 S 1ST ST STE 215
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3442
Practice Address - Country:US
Practice Address - Phone:972-926-1199
Practice Address - Fax:972-278-6830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0999732-01Medicaid
TX00RE36Medicare UPIN
TX00RE36Medicare ID - Type Unspecified