Healthcare Provider Details

I. General information

NPI: 1982612859
Provider Name (Legal Business Name): PORFIRIO S RODRIGUEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2768 PHARMACY RD
RIO GRANDE CITY TX
78582-6201
US

IV. Provider business mailing address

2768 PHARMACY RD
RIO GRANDE CITY TX
78582-6201
US

V. Phone/Fax

Practice location:
  • Phone: 956-487-5621
  • Fax: 956-487-5862
Mailing address:
  • Phone: 956-487-5621
  • Fax: 956-487-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF2886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: