Provider Demographics
NPI:1871629253
Name:RODRIGUEZ, RAFAEL M (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE 690
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-979-6863
Mailing Address - Fax:210-979-7434
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE 690
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-979-6863
Practice Address - Fax:210-979-7434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH3740207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033473201Medicaid
TXE74616Medicare UPIN
TX00G44JMedicare PIN