Provider Demographics
NPI:1881832525
Name:RODRIGUEZ, GABRIEL A (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
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 1:7709 SAN JACINTO PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3215
Mailing Address - Country:US
Mailing Address - Phone:214-709-1904
Mailing Address - Fax:214-292-9329
Practice Address - Street 1:7709 SAN JACINTO PL
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3215
Practice Address - Country:US
Practice Address - Phone:214-709-1904
Practice Address - Fax:214-292-9329
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96660207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN207ZMedicare PIN