MEDICARE: JAMES ENRIQUE RODRIGUEZ VARGAS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03671	TX

General Provider Information

NPI Number	:	1003819855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ENRIQUE RODRIGUEZ VARGAS P.A.

Provider Business Mailing Address
First Line	:	3607 RIVERA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2415
Country	:	US
Telephone Number	:	915-533-7057
Fax Number	:	915-757-1640

Provider Business Practice Location Address
First Line	:	6974 GATEWAY BLVD E
Second Line	:	STE F
City	:	EL PASO
State	:	TX
Zip	:	79915-1115
Country	:	US
Telephone Number	:	915-591-2704
Fax Number	:	915-598-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/14/2011

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