Provider Demographics
NPI:1912065954
Name:RODRIGUEZ, JORGE S (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:S
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 1:3845 SPID
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415
Mailing Address - Country:US
Mailing Address - Phone:361-854-4626
Mailing Address - Fax:361-851-5193
Practice Address - Street 1:3845 SPID
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415
Practice Address - Country:US
Practice Address - Phone:361-854-4626
Practice Address - Fax:361-851-5193
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6791173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0938326-01Medicaid