Healthcare Provider Details

I. General information

NPI: 1578776860
Provider Name (Legal Business Name): ROBERT L RODRIGUES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

2222 S DOBSON RD SUITE 1100
MESA AZ
85202-6481
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-0212
  • Fax:
Mailing address:
  • Phone: 480-839-3313
  • Fax: 480-839-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20171
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: