Healthcare Provider Details

I. General information

NPI: 1578531851
Provider Name (Legal Business Name): EMILIO J. RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W 7TH ST
COLUMBIA TN
38401-1810
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-9706
  • Fax: 931-490-1062
Mailing address:
  • Phone: 931-388-9706
  • Fax: 931-490-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number021471
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: