Provider Demographics
NPI:1629466107
Name:RODRIGUEZ, RAMON JR (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMON
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15826 E CHICORY DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4309
Mailing Address - Country:US
Mailing Address - Phone:480-836-4553
Mailing Address - Fax:888-999-6630
Practice Address - Street 1:15826 E CHICORY DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4309
Practice Address - Country:US
Practice Address - Phone:480-836-4553
Practice Address - Fax:888-999-6630
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ16415207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD4413Medicare UPIN