Provider Demographics
NPI:1619205804
Name:DRU L. RODRIGUEZ DPM PS
Entity Type:Organization
Organization Name:DRU L. RODRIGUEZ DPM PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DRU
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-327-7733
Mailing Address - Street 1:8606 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2034
Mailing Address - Country:US
Mailing Address - Phone:509-327-7733
Mailing Address - Fax:509-327-2284
Practice Address - Street 1:8606 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2034
Practice Address - Country:US
Practice Address - Phone:509-327-7733
Practice Address - Fax:509-327-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-26
Last Update Date:2009-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000486332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099282Medicaid
WAU31022Medicare UPIN