1902191844 NPI number — DR. ANTONIO AARON RODRIGUEZ MD

Table of content: (NPI 1114292695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902191844 NPI number — DR. ANTONIO AARON RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
ANTONIO
Provider Middle Name:
AARON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1902191844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5917 CROSSTOWN EXPRESSWAY SH 286
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-854-0811
Provider Business Mailing Address Fax Number:
361-806-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 COLONY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-235-0299
Provider Business Practice Location Address Fax Number:
580-235-0297
Provider Enumeration Date:
06/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  276183 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: Q6465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: BP1-00040918 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PS0010X , with the licence number: Q6465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 362584005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04065821 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8FZ000 . This is a "BC/BS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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