Provider Demographics
NPI:1023055340
Name:RODRIGUEZ, REYNALDO (DO)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:334-836-1888
Practice Address - Street 1:3601 SPRINGHILL BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1256
Practice Address - Country:US
Practice Address - Phone:251-873-6192
Practice Address - Fax:251-873-6193
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-510207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009928600Medicaid
FL255684700Medicaid
GA020031650OtherRAILORAD MEDICARE PTAN
AL51028994OtherBCBS
AL29-10274OtherUNITED HEALTHCARE
AL009958940Medicaid
AL51096054OtherBCBS
MS00120906Medicaid
AL29-10274OtherUNITED HEALTHCARE
AL000096054Medicare PIN