Provider Demographics
NPI:1669660882
Name:RODRIGUEZ, RYAN MICHAEL (PA-C, ATC)
Entity Type:Individual
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First Name:RYAN
Middle Name:MICHAEL
Last Name:RODRIGUEZ
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Gender:M
Credentials:PA-C, ATC
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Mailing Address - Street 1:9040A JACKSON AVE
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-9500
Mailing Address - Country:US
Mailing Address - Phone:253-968-1574
Mailing Address - Fax:253-968-3148
Practice Address - Street 1:9040A JACKSON AVE
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-9500
Practice Address - Country:US
Practice Address - Phone:253-968-1574
Practice Address - Fax:253-968-3148
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-09-16
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Provider Licenses
StateLicense IDTaxonomies
WA60229753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant