MEDICARE: DR. RODOLFO J WALSS 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	207VX0000X	Obstetrics Physician	J1423	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184683104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODOLFO J WALSS M.D.

Provider Business Mailing Address
First Line	:	4770 N EXPRESSWAY
Second Line	:	205
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-350-0838
Fax Number	:	956-350-2141

Provider Business Practice Location Address
First Line	:	4770 N EXPRESSWAY
Second Line	:	205
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-350-0838
Fax Number	:	956-350-2141

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	06/03/2008

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