Provider Demographics
NPI:1720086507
Name:RODRIGUEZ, ERIC JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
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 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:602-521-6200
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:2323 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2530
Practice Address - Country:US
Practice Address - Phone:602-521-6200
Practice Address - Fax:623-842-5640
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP01202167OtherRAILROAD MEDICARE PIN
AZZ158052Medicare PIN
H82579Medicare UPIN
AZZ159286Medicare PIN
AZZ158053Medicare PIN
AZZ159287Medicare PIN