Healthcare Provider Details

I. General information

NPI: 1649231275
Provider Name (Legal Business Name): UBALDO R RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HERITAGE LNDG STE 215
SAINT PETERS MO
63303-8489
US

IV. Provider business mailing address

1600 HERITAGE LNDG STE 215
SAINT PETERS MO
63303-8489
US

V. Phone/Fax

Practice location:
  • Phone: 636-939-4200
  • Fax: 636-939-4204
Mailing address:
  • Phone: 636-939-4200
  • Fax: 636-939-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: