Healthcare Provider Details

I. General information

NPI: 1851344212
Provider Name (Legal Business Name): ALWYN MILTON RODRIGUES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

IV. Provider business mailing address

21706 MAY APPLE COURT
CYPRESS TX
77433
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-2568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM2464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: