Healthcare Provider Details

I. General information

NPI: 1164472213
Provider Name (Legal Business Name): ALFRED JOSEPH RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W PARKER RD SUITE 215
PLANO TX
75093-7939
US

IV. Provider business mailing address

6200 W PARKER RD SUITE 215
PLANO TX
75093-7939
US

V. Phone/Fax

Practice location:
  • Phone: 972-981-7800
  • Fax: 972-981-7808
Mailing address:
  • Phone: 972-981-7800
  • Fax: 972-981-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberE6588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: