Provider Demographics
NPI:1861403628
Name:RODRIGUES, CELSO FERREIRA (MD)
Entity type:Individual
Prefix:DR
First Name:CELSO
Middle Name:FERREIRA
Last Name:RODRIGUES
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 1:2674 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2024
Mailing Address - Country:US
Mailing Address - Phone:636-461-2711
Mailing Address - Fax:
Practice Address - Street 1:2674 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2024
Practice Address - Country:US
Practice Address - Phone:636-461-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH48037Medicare UPIN