Provider Demographics
NPI:1205129541
Name:RODRIGUEZ, RAUL PEDRO (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:PEDRO
Last Name:RODRIGUEZ
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 1:7150 GREENVILLE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7916
Mailing Address - Country:US
Mailing Address - Phone:214-234-0413
Mailing Address - Fax:
Practice Address - Street 1:7150 GREENVILLE AVE STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7916
Practice Address - Country:US
Practice Address - Phone:214-234-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5549208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE77608Medicare UPIN