Provider Demographics
NPI:1760463392
Name:RODRIGUEZ, BRETT C (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name: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 1:1055 PARKWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6276
Mailing Address - Country:US
Mailing Address - Phone:318-352-6464
Mailing Address - Fax:318-352-2488
Practice Address - Street 1:1055 PARKWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6276
Practice Address - Country:US
Practice Address - Phone:318-352-6464
Practice Address - Fax:318-352-2488
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD023201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495476Medicaid