MEDICARE: NIDRA I RODRIGUEZ M.D.

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	208000000X	Pediatrics Physician	M2053	TX
2	2080P0207X	Pediatric Hematology & Oncology Physician	M2053	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	176057102	OTHER	TX	CSHCN
2	8K9798	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073541223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDRA I RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	7000 FANNIN ST STE 700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-8345
Fax Number	:	713-500-8348

Provider Business Practice Location Address
First Line	:	7000 FANNIN ST STE 750
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-8360
Fax Number	:	713-500-8364

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/07/2023

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