Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | K4214 | TX |
NPI | 1003893793 |
---|---|
Provider Name | Dr. Renaud P. Rodrigue |
First Address | Dallas, TX 75231-4482 |
Second Address | Dallas, TX 75231-4482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0094YB | BCBS (01) |