Provider Demographics
NPI:1144262247
Name:RODRIGUEZ, DRU LOUIS (DPM)
Entity type:Individual
Prefix:
First Name:DRU
Middle Name:LOUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPM
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 18977
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-0977
Mailing Address - Country:US
Mailing Address - Phone:509-327-7733
Mailing Address - Fax:509-327-2284
Practice Address - Street 1:1333 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6730
Practice Address - Country:US
Practice Address - Phone:509-327-7733
Practice Address - Fax:509-327-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000486213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099282Medicaid
WA905-4628OtherDSHS DME
WA905-4628OtherDSHS DME
WAU31022Medicare UPIN