Provider Demographics
NPI:1619097797
Name:O.J. RODRIGUEZ, MD PA
Entity Type:Organization
Organization Name:O.J. RODRIGUEZ, MD PA
Other - Org Name:OCTAVIO J. RODRIGUEZ, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:361-595-5556
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130853801Medicaid
TX130853801Medicaid
TX=========OtherTAX IDENTIFIER