Provider Demographics
NPI:1013977222
Name:RODRIGUEZ, MARTIN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24775207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51598424OtherBLUE CROSS & BLUE SHIELD
AL110423Medicaid
AL121942Medicaid
AL110421Medicaid
P00821369OtherRAILROAD MEDICARE
MS00453705Medicaid
AL51598423OtherBLUE CROSS & BLUE SHIELD
AL051556574Medicaid
AL110405Medicaid
636005396005OtherHUMANA GOLD CHOICE MEDICARE
AL051001527OtherBCBS
102I204284OtherMEDICARE
AL51598425OtherBLUE CROSS & BLUE SHIELD
AL51598429OtherBLUE CROSS & BLUE SHIELD
AL110406Medicaid
AL51598426OtherBLUE CROSS & BLUE SHIELD
MS00453705Medicaid
AL121942Medicaid
AL051001527OtherBCBS