=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477645562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRED HENRY RODRIGUEZ JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 02/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 POYDRAS ST SUITE #1300
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70112-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-556-7290
-----------------------------------------------------
Fax | 504-556-7350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5105 GREEN ACRES CT
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70003-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-888-8018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 013267
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------