Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5749TG | TX |
NPI | 1003820168 |
---|---|
Provider Name | Dr. Jaime Rodriguez |
First Address | Weslaco, TX 78596-5395 |
Second Address | Weslaco, TX 78596-5395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 18/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00E70Z | BLUE CROSS BLUE SHIELD (01) | TX |
0306300-01 | (05) | TX |
U75498 | (02) | TX |