Provider Demographics
NPI:1730101940
Name:RODRIGUEZ, GABRIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1629
Mailing Address - Country:US
Mailing Address - Phone:502-458-8653
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1000 SAINT CHRISTOPHER DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7034
Practice Address - Country:US
Practice Address - Phone:606-833-3634
Practice Address - Fax:606-836-9914
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39824207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
608673400OtherUS DEPT OF LABOR
KY64113780Medicaid
P00283613OtherRAILROAD MEDICARE
KY000000388383OtherANTHEM BLUE CROSS BS
WV3810005530Medicaid
608673400OtherBLACK LUNG PROGRAM
KY50007952OtherPASSPORT MEDICAID
WV3810005530Medicaid
KY50007952OtherPASSPORT MEDICAID