Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | BP10049288 | TX |
NPI | 1003227018 |
---|---|
Provider Name | Jesus Rodriguez |
First Address | Harlingen, TX 78550-8532 |
Second Address | Harlingen, TX 78550-8532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 06/01/2016 |