Healthcare Provider Details

I. General information

NPI: 1184717381
Provider Name (Legal Business Name): HUMBERTO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 ALCOA HWY STE 303
KNOXVILLE TN
37920-1502
US

IV. Provider business mailing address

DEPT 888064
KNOXVILLE TN
37995-0001
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9305
  • Fax:
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD17806
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: