Provider Demographics
NPI:1619007689
Name:RODRIGUES, VICTOR J (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:125 EL PASO RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6033
Practice Address - Country:US
Practice Address - Phone:575-630-4230
Practice Address - Fax:575-630-4237
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0658207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine