Healthcare Provider Details

I. General information

NPI: 1417061631
Provider Name (Legal Business Name): JOHN C RODRIGUES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE # 3A
EVANSVILLE IN
47714-0541
US

IV. Provider business mailing address

3700 WASHINGTON AVE # A
EVANSVILLE IN
47714-0541
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-7680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01067612A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01067612A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number01067612A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: