Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 12382 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 12382 | TX |
N | 1223X0008X | Oral and Maxillofacial Radiology | 12382 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 12382 | TX |
NPI | 1174521843 |
---|---|
Provider Name | Dr. Edward F Rod JR. |
First Address | Beaumont, TX 77702-1845 |
Second Address | Beaumont, TX 77702-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 30/07/2007 |