1649257270 NPI number — RUFUS RODRIGUEZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649257270 NPI number — RUFUS RODRIGUEZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RODRIGUEZ

Provider First Name:

RUFUS

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1649257270

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/18/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

800 MEDICAL CENTER DR

Provider Second Line Business Mailing Address:

PO BOX 800

Provider Business Mailing Address City Name:

FAIRMONT

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56031-4575

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

507-238-8555

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

800 MEDICAL CENTER DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FAIRMONT

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56031-4575

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

507-238-8555

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

12/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  34501 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 16-03136 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 119872 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 861S7RO . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 861S7RO , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 2055380 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 38408 . This is a "SIOUX VALLEY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 9958 . This is a "AVERA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: MH9041013411 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 584680 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 695523100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP17646 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".