Provider Demographics
NPI:1649332578
Name:RODRIGUEZ, LUZ ESTHER (MD,)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:ESTHER
Last Name:RODRIGUEZ
Suffix:
Gender:F
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:PO BOX 70
Mailing Address - Street 2:100 CHEYENNE AVE
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043-0070
Mailing Address - Country:US
Mailing Address - Phone:406-477-4518
Mailing Address - Fax:406-477-4427
Practice Address - Street 1:100 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0070
Practice Address - Country:US
Practice Address - Phone:406-477-4518
Practice Address - Fax:406-477-4427
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25561208000000X
FLME504682080A0000X
MT99922080A0000X
NJMA450352080A0000X
NY174532-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047139900Medicaid
FL047139900Medicaid