=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528279924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SERGIO RODRIGUEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5121 S MCCOLL RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-8278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-362-6730
-----------------------------------------------------
Fax | 956-362-6745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4624
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78502-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-362-6730
-----------------------------------------------------
Fax | 956-362-6745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Surgery) Physician
-----------------------------------------------------
License Number | M8961
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------