Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 48028 | MN |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 6172029-1205 | UT |
NPI | 1316910748 |
---|---|
Provider Name | Robert L Rodrigues |
First Address | West Valley City, UT 84120-5530 |
Second Address | West Valley City, UT 84120-5530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 13/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
620176800 | (05) | MN |
I35127 | (02) |