Provider Demographics
NPI:1013974518
Name:RODRIQUEZ, ANTONIO C (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:C
Last Name:RODRIQUEZ
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 1:8607 MCPHERSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-728-8400
Mailing Address - Fax:956-728-9445
Practice Address - Street 1:8607 MCPHERSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-728-8400
Practice Address - Fax:956-728-9445
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2371174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121280504Medicaid
TX121280503Medicaid
TXG55721Medicare UPIN