Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 234802 | NY |
N | 111NI0900X | Internist | 234802 | NY |
Y | 207RG0100X | Gastroenterologist | 25049 | WV |
N | 207RG0100X | Gastroenterologist | ME89177 | FL |
NPI | 1003937244 |
---|---|
Provider Name | Dr. Tomas Rodriguez Molinet |
First Address | Bridgeport, WV 26330-9010 |
Second Address | Bridgeport, WV 26330-9010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25049 | STATE MEDICAL LICENSE (01) | WV |
3810024066 | MEDICAID (01) | WV |
P01178675 | RR MEDICARE PTAN (01) | WV |
WV1851A | MEDICARE PTAN (01) | WV |