Provider Demographics
NPI:1396795852
Name:RODRIGUEZ, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 360283
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0283
Mailing Address - Country:US
Mailing Address - Phone:787-740-5349
Mailing Address - Fax:787-782-3272
Practice Address - Street 1:TORRE SAN PABLO
Practice Address - Street 2:SUITE 301 CALLE STA. CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7031
Practice Address - Country:US
Practice Address - Phone:787-995-1559
Practice Address - Fax:787-780-3272
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5669207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0024596Medicare PIN
PRD38188Medicare UPIN