MEDICARE: LEO RODRIGUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	J3377	TX

General Provider Information

NPI Number	:	1174527006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	7121 S SPID DR
Second Line	:	STE 200
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-4940
Country	:	US
Telephone Number	:	361-993-6000
Fax Number	:	361-993-3676

Provider Business Practice Location Address
First Line	:	2481 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-882-6080
Fax Number	:	361-882-6089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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