Provider Demographics
NPI:1396935011
Name:RODRIGUEZ, GUSTAVO J (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:J
Last Name:RODRIGUEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:440 RAYNOLDS MSC 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2709
Mailing Address - Country:US
Mailing Address - Phone:915-215-5389
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4800 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2709
Practice Address - Country:US
Practice Address - Phone:915-215-5911
Practice Address - Fax:915-215-5969
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2018-05-24
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Provider Licenses
StateLicense IDTaxonomies
TXP5565207T00000X, 2084D0003X, 2084A2900X, 2084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare UPIN