Provider Demographics
NPI:1922020106
Name:RODRIGUEZ, LORI LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LEE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 HIGHWAY 494
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2826
Mailing Address - Country:US
Mailing Address - Phone:318-228-9411
Mailing Address - Fax:
Practice Address - Street 1:1055 PARKWAY DR STE A
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6276
Practice Address - Country:US
Practice Address - Phone:318-228-9411
Practice Address - Fax:318-352-2488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022137207R00000X
LAMD.022137173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495506Medicaid
LA5Y378Medicare ID - Type Unspecified