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NPI Code Detail

MEDICARE: MR. JOSE ABRAHAM RODRIGUEZ MD

MEDICARE: MR. JOSE ABRAHAM RODRIGUEZ MD
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
1208000000XPediatrics Physician19905MS

Other Identifiers

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

General Provider Information

NPI Number : 1780779579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE ABRAHAM RODRIGUEZ MD
Provider Business Mailing Address
First Line : 114 N LEHMBERG RD
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-5554
Country : US
Telephone Number : 662-329-2955
Fax Number : 662-370-1236
Provider Business Practice Location Address
First Line : 114 N LEHMBERG RD
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-5554
Country : US
Telephone Number : 662-329-2955
Fax Number : 662-370-1236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 09/22/2025

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