Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036075204 | IL |
Y | 207VX0201X | Gynecologic Oncologist | 036075204 | IL |
NPI | 1265527956 |
---|---|
Provider Name | Gustavo Rodriguez |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E14084 | (02) | IL |