Healthcare Provider Details

I. General information

NPI: 1760463392
Provider Name (Legal Business Name): BRETT C RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 PARKWAY DR SUITE A
NATCHITOCHES LA
71457-6276
US

IV. Provider business mailing address

1055 PARKWAY DR SUITE A
NATCHITOCHES LA
71457-6276
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-6464
  • Fax: 318-352-2488
Mailing address:
  • Phone: 318-352-6464
  • Fax: 318-352-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD023201
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: