Provider Demographics
NPI:1942234216
Name:RODRIGUEZ, LUIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-593-5700
Mailing Address - Fax:210-593-5992
Practice Address - Street 1:155 E SONTERRA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3987
Practice Address - Country:US
Practice Address - Phone:210-593-5700
Practice Address - Fax:210-593-5992
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6161207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158693502Medicaid
7654274OtherAETNA PIN #
TX8C8215OtherMEDICARE PTAN
H86942Medicare UPIN