Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | DO-510 | AL |
NPI | 1023055340 |
---|---|
Provider Name | Reynaldo Rodriguez |
First Address | Dothan, AL 36305-1156 |
Second Address | Mobile, AL 36608-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00120906 | (05) | MS |
009928600 | (05) | AL |
009958940 | (05) | AL |
020031650 | RAILORAD MEDICARE PTAN (01) | GA |
255684700 | (05) | FL |
29-10274 | UNITED HEALTHCARE (01) | AL |
51028994 | BCBS (01) | AL |
51096054 | BCBS (01) | AL |
G39166 | (02) |