Provider Demographics
NPI:1639274814
Name:RODRIGUEZ GONZALEZ, EDGAR A (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:A
Last Name:RODRIGUEZ GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDGAR
Other - Middle Name:A
Other - Last Name:RODRIGUEZ GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:576 CALLE CESAR GONZALEZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3756
Mailing Address - Country:US
Mailing Address - Phone:787-274-5405
Mailing Address - Fax:787-274-5406
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3756
Practice Address - Country:US
Practice Address - Phone:787-274-5405
Practice Address - Fax:787-274-5406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9954207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF13145Medicare UPIN