Provider Demographics
NPI:1710316450
Name:RODRIGUEZ JEREZ, ROBERTO DAVID (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:DAVID
Last Name:RODRIGUEZ JEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:DAVID
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:821 S LEAVITT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3617
Mailing Address - Country:US
Mailing Address - Phone:773-257-5286
Mailing Address - Fax:
Practice Address - Street 1:821 S LEAVITT ST FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4209
Practice Address - Country:US
Practice Address - Phone:773-257-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology