Provider Demographics
NPI:1760098248
Name:RODRIGUEZ, EDDIE L
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 S ROLLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-4872
Mailing Address - Country:US
Mailing Address - Phone:918-849-6388
Mailing Address - Fax:
Practice Address - Street 1:3821 S ROLLING OAKS DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-4872
Practice Address - Country:US
Practice Address - Phone:918-849-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist