Provider Demographics
NPI:1255360673
Name:RODRIGUEZ-MALDONADO, JOSE MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARIA
Last Name:RODRIGUEZ-MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:M
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:177 KNIGHTSBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-2605
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:843-987-4798
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48608207P00000X, 207R00000X
IN01086626A207P00000X, 207R00000X
SC26488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC264886Medicaid
SCI04314Medicare UPIN