Provider Demographics
NPI:1174542351
Name:RODRIGUEZ, ORSON P (MD)
Entity type:Individual
Prefix:
First Name:ORSON
Middle Name:P
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4376
Practice Address - Street 1:2355 E GRAPEVINE MILLS CIR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2047
Practice Address - Country:US
Practice Address - Phone:972-539-6330
Practice Address - Fax:972-539-3077
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23389207Q00000X
TXQ3282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23389OtherLICENSE
OK23389OtherLICENSE