Provider Demographics
NPI:1750327888
Name:RODRIGUEZ RODRIGUEZ, JESUS W (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:W
Last Name:RODRIGUEZ 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 664
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0664
Mailing Address - Country:US
Mailing Address - Phone:787-812-3939
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 132 KM.22.1 BO CANAS
Practice Address - Street 2:PLAZA GABRIELA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-812-3939
Practice Address - Fax:787-812-3931
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13376208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR201908OtherU.T.I.
PR7310383OtherHUMANA
PR200095OtherMEDICARE Y MUCHO MAS
PRPG-4131OtherPAN AMERICANLIFE
PR100832OtherCRUZ AZUL
PR20326OtherTRIPLE S
PR7310383OtherHUMANA
PR100832OtherCRUZ AZUL