Provider Demographics
NPI:1720736127
Name:BROWN, RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:RODRIGUEZ
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8486 FRIEDEN TRL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3348
Mailing Address - Country:US
Mailing Address - Phone:901-860-1885
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2328
Practice Address - Country:US
Practice Address - Phone:901-860-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN079487198172A00000X
174200000X, 253Z00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care