Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 23096 | KY |
Y | 208600000X | Surgeon | 23096 | KY |
N | 2086S0102X | Surgical Critical Care | 23096 | KY |
NPI | 1023088911 |
---|---|
Provider Name | Jorge Luis Rodriguez |
First Address | Louisville, KY 40295-0202 |
Second Address | Louisville, KY 40207-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 19/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100386510 | (05) | IN |
1153806 | PASSPORT (01) | KY |
64042906 | (05) | KY |
E19211 | (02) |