Provider Demographics
NPI:1023057668
Name:RODRIGUEZ, LINDA M (DO)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11449
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:918-962-2442
Mailing Address - Fax:918-962-3895
Practice Address - Street 1:702 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-2430
Practice Address - Country:US
Practice Address - Phone:918-962-2442
Practice Address - Fax:918-962-3895
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100256710AMedicaid
AR138645003Medicaid
OK100256710AMedicaid