Provider Demographics
NPI:1689635195
Name:RODRIGUEZ, RAMON III (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ
Suffix:III
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E MAIN ST
Mailing Address - Street 2:SUITE 1701
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3531
Mailing Address - Country:US
Mailing Address - Phone:804-782-0608
Mailing Address - Fax:804-782-0133
Practice Address - Street 1:1111 E MAIN ST
Practice Address - Street 2:SUITE 1701
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3531
Practice Address - Country:US
Practice Address - Phone:804-782-0608
Practice Address - Fax:804-782-0133
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223904207Q00000X
ARC-8408207Q00000X
FLME66807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010110017Medicaid
AR123772001Medicaid
VA006013S33Medicare ID - Type Unspecified
VA010110017Medicaid