Provider Demographics
NPI:1295734176
Name:RODRIGUEZ, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:8038 WURZBACH RD
Mailing Address - Street 2:510
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3817
Mailing Address - Country:US
Mailing Address - Phone:210-692-7171
Mailing Address - Fax:210-615-1161
Practice Address - Street 1:8038 WURZBACH RD
Practice Address - Street 2:510
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3817
Practice Address - Country:US
Practice Address - Phone:210-692-7171
Practice Address - Fax:210-615-1161
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXD9638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035268401Medicaid
TXC21217Medicare UPIN
TX035268401Medicaid