MEDICARE: JOSE RAUL 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	208600000X	Surgery Physician	E0278	TX
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	E0278	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	020045338	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00N027	OTHER	TX	BLUE CROSS BLUE SHIELD OF TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376503078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE RAUL RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	23 TERRAVALE CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-3504
Country	:	US
Telephone Number	:	956-459-7027
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 TERRAVALE CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-3504
Country	:	US
Telephone Number	:	956-459-7027
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	01/26/2021

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