Provider Demographics
NPI:1679640411
Name:RODRIGUEZ, RICARDO (MD)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
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:PO BOX 5396
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5396
Mailing Address - Country:US
Mailing Address - Phone:806-741-3620
Mailing Address - Fax:806-741-3563
Practice Address - Street 1:3401 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-741-3620
Practice Address - Fax:806-741-3563
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00216470OtherRAILROAD MEDICARE
84C717Medicare ID - Type Unspecified
D67665Medicare UPIN