Provider Demographics
NPI:1619074929
Name:RODRIGUEZ, OCTAVIO J II (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:J
Last Name:RODRIGUEZ
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OJ
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1597
Mailing Address - Country:US
Mailing Address - Phone:361-595-5556
Mailing Address - Fax:361-595-0295
Practice Address - Street 1:1021 SENATOR CARLOS TRUAN BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6667
Practice Address - Country:US
Practice Address - Phone:361-595-5556
Practice Address - Fax:361-595-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130853801Medicaid
TX00U10WMedicare ID - Type Unspecified
TX130853801Medicaid