=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881009025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOEL A RODRIGUEZ MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2014
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3103 SE MILITARY DR SUITE 105
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78223-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-359-0051
-----------------------------------------------------
Fax | 888-290-1413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 791413
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78279-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-359-0051
-----------------------------------------------------
Fax | 888-290-1413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | JOEL A RODRIGUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-359-0051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | N6622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------