Provider Demographics
NPI:1710948773
Name:RODRIGUEZ, MANUEL ALVAREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ALVAREZ
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:ALVAREZ
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SENIOR STAFF MEDICAL
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-0666
Mailing Address - Country:US
Mailing Address - Phone:605-232-9600
Mailing Address - Fax:
Practice Address - Street 1:HWY 75 77
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-2231
Practice Address - Fax:402-878-2535
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8HZ66FMedicare ID - Type Unspecified
D67667Medicare UPIN