MEDICARE: DR. DAVID ANTHONY RODRIGUEZ JR. 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	2084P0804X	Child & Adolescent Psychiatry Physician	Q4504	TX
2	2084P0800X	Psychiatry Physician	Q4504	TX

General Provider Information

NPI Number	:	1407177124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANTHONY RODRIGUEZ JR. M.D.

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1060
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	5210 THOUSAND OAKS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-6974
Country	:	US
Telephone Number	:	210-261-4416
Fax Number	:	210-261-1833

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	09/06/2023

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