Provider Demographics
NPI:1649480534
Name:KADOUR RODRIGUEZ, JACINTO OMAR (MD)
Entity type:Individual
Prefix:
First Name:JACINTO
Middle Name:OMAR
Last Name:KADOUR RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 E 8TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5587
Mailing Address - Country:US
Mailing Address - Phone:956-630-1000
Mailing Address - Fax:956-213-0607
Practice Address - Street 1:1604 E 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5587
Practice Address - Country:US
Practice Address - Phone:956-447-5557
Practice Address - Fax:956-447-5747
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085439207R00000X
TXS9324207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX427625501Medicaid