Provider Demographics
NPI:1861438053
Name:RODRIGUEZ, ROBERT B JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:RODRIGUEZ
Suffix:JR
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 1:405 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3588
Mailing Address - Country:US
Mailing Address - Phone:469-865-1850
Mailing Address - Fax:469-865-1855
Practice Address - Street 1:405 STADIUM DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3588
Practice Address - Country:US
Practice Address - Phone:469-865-1850
Practice Address - Fax:469-865-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141983001Medicaid
TX141983001Medicaid
00982MMedicare PIN