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General NPI Number Information
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NPI Number | 1184623886
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Entity Type | Individual
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Provider Name | JACK JOSEPH RODRIGUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 106 JEFFERSON DAVIS BLVD SUITE 120
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City | NATCHEZ
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State | MS
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Zip | 39120-5104
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Country | US
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Telephone | 601-442-9210
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Fax | 601-442-7409
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Provider Business Mailing Address
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Address Line | 400 S COMMERCE ST
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City | NATCHEZ
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State | MS
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Zip | 39120-3506
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Country | US
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Telephone | 601-442-9210
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Fax | 601-442-7409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 15252
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License Number State | MS
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