Provider Demographics
NPI:1619983780
Name:RODRIGUEZ, OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
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 1:1413 7TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2214
Mailing Address - Country:US
Mailing Address - Phone:337-468-3392
Mailing Address - Fax:337-468-3322
Practice Address - Street 1:1413 7TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2214
Practice Address - Country:US
Practice Address - Phone:337-468-3392
Practice Address - Fax:337-468-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA05521R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1314544Medicaid
LAB65884Medicare UPIN
LA1314544Medicaid