Provider Demographics
NPI:1023031218
Name:RODRIGUEZ, ELEAZAR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ELEAZAR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001, DEPT 8340
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:855-536-7277
Mailing Address - Fax:855-830-1722
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5003
Practice Address - Country:US
Practice Address - Phone:956-797-2002
Practice Address - Fax:956-922-0250
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03117OtherSTATE LICENSE
TXPA03117OtherSTATE LICENSE