Provider Demographics
NPI:1336348747
Name:RODRIGUEZ, ROBERTO H (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:H
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28580 INTERSTATE 10 W UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9106
Mailing Address - Country:US
Mailing Address - Phone:830-981-5150
Mailing Address - Fax:830-981-5159
Practice Address - Street 1:28580 INTERSTATE 10 W UNIT 3
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9106
Practice Address - Country:US
Practice Address - Phone:830-981-5150
Practice Address - Fax:830-981-5159
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1826213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187876103Medicaid
TX8L11005Medicare PIN