Provider Demographics
NPI:1689625741
Name:RODRIGUEZ, JAIRO (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
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 532201
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2201
Mailing Address - Country:US
Mailing Address - Phone:956-428-7862
Mailing Address - Fax:956-440-0395
Practice Address - Street 1:893 S SAM HOUSTON BLVD
Practice Address - Street 2:STE B
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3062
Practice Address - Country:US
Practice Address - Phone:956-626-2500
Practice Address - Fax:956-626-2503
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8460207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030837104Medicaid
TX030837101Medicaid
TX030837102Medicaid
TX8A9370OtherBLUE CROSS BLUE SHIELD
TX8A9370OtherBLUE CROSS BLUE SHIELD
TX8A1842Medicare PIN