Provider Demographics
NPI:1740249853
Name:RODRIGUEZ, LUIS ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERNESTO
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:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-3148
Mailing Address - Fax:252-209-3146
Practice Address - Street 1:500 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3248
Practice Address - Country:US
Practice Address - Phone:252-209-3148
Practice Address - Fax:252-209-3146
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001617207P00000X
NC2000-01617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13087OtherBCBS OF NC
NC70176OtherMEDCOST
NC8913087Medicaid
NC13087OtherBCBS OF NC
NC70176OtherMEDCOST