MEDICARE: JACK JOSEPH 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	207RH0003X	Hematology & Oncology Physician	15252	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184623886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK JOSEPH RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	400 S COMMERCE ST
Second Line	:
City	:	NATCHEZ
State	:	MS
Zip	:	39120-3506
Country	:	US
Telephone Number	:	601-442-9210
Fax Number	:	601-442-7409

Provider Business Practice Location Address
First Line	:	106 JEFFERSON DAVIS BLVD
Second Line	:	SUITE 120
City	:	NATCHEZ
State	:	MS
Zip	:	39120-5104
Country	:	US
Telephone Number	:	601-442-9210
Fax Number	:	601-442-7409

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	02/01/2018

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