Healthcare Provider Details

I. General information

NPI: 1649332578
Provider Name (Legal Business Name): LUZ ESTHER RODRIGUEZ M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHEYENNE AVE
LAME DEER MT
59043-0070
US

IV. Provider business mailing address

PO BOX 70 100 CHEYENNE AVE
LAME DEER MT
59043-0070
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4518
  • Fax: 406-477-4427
Mailing address:
  • Phone: 406-477-4518
  • Fax: 406-477-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25561
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME50468
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9992
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA45035
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number174532-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: