Provider Demographics
NPI:1912929456
Name:RODRIGUEZ, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
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 1:110 E SAVANNAH AVE BLDG C101
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1242
Mailing Address - Country:US
Mailing Address - Phone:956-686-2626
Mailing Address - Fax:956-686-1616
Practice Address - Street 1:110 E SAVANNAH AVE BLDG C101
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-686-2626
Practice Address - Fax:956-686-1616
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4303294OtherAETNA US HEALTHCARE
TX2900177OtherUNITED HEALTHCARE
TX1661548OtherCIGNA HEALTHCARE
TX80T051OtherBCBS OF TEXAS
TX2900177OtherUNITED HEALTHCARE
TXD97675Medicare UPIN
TX136656617Medicaid
TX00Y580Medicare UPIN