Provider Demographics
NPI:1710915004
Name:RODRIGUEZ, LUIS R (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1714 E YANDELL DR
Mailing Address - Street 2:#B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5715
Mailing Address - Country:US
Mailing Address - Phone:915-544-6287
Mailing Address - Fax:915-544-6288
Practice Address - Street 1:1714 E YANDELL DR
Practice Address - Street 2:#B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5715
Practice Address - Country:US
Practice Address - Phone:915-544-6287
Practice Address - Fax:915-544-6288
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD3387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F818OtherBC & BS OF TEXAS
TX1146813-02Medicaid
NM000X2975OtherNEW MEXICO MEDICAID
TXC21212Medicare UPIN
TX1146813-02Medicaid
NM000X2975OtherNEW MEXICO MEDICAID