Healthcare Provider Details

I. General information

NPI: 1184865172
Provider Name (Legal Business Name): JAKE JOSEPH RODI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10656 HIGHWAY 23
BELLE CHASSE LA
70037-4342
US

IV. Provider business mailing address

13423 BLANCO ROAD PMB 136
SAN ANTONIO TX
78216
US

V. Phone/Fax

Practice location:
  • Phone: 504-386-9003
  • Fax: 504-324-0416
Mailing address:
  • Phone: 210-890-8840
  • Fax: 210-783-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.204199
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: