=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568777373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALFREDO RODRIGUEZ M D & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2010
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2540 N GALLOWAY AVE SUITE # 301
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-7585
-----------------------------------------------------
Fax | 972-613-3334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2540 N GALLOWAY AVE SUITE # 301
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-7585
-----------------------------------------------------
Fax | 972-613-3334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALFREDO DM RODRIGUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-270-7585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MDF3594
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------