Provider Demographics
NPI: | 1174555072 |
---|---|
Name: | RODRIGUEZ, JAVIER FRANCISCO (PA) |
Entity type: | Individual |
Prefix: | |
First Name: | JAVIER |
Middle Name: | FRANCISCO |
Last Name: | RODRIGUEZ |
Suffix: | |
Gender: | M |
Credentials: | PA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | ONE VANTAGE WAY |
Mailing Address - Street 2: | SUITE B240 MIDDLE TENNESSEE EMERGENCY PHYSICIAN, PC |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37228-1562 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-329-4020 |
Mailing Address - Fax: | 615-329-9479 |
Practice Address - Street 1: | 400 N. HIGHLAND AVE. |
Practice Address - Street 2: | MIDDLE TENNESSEE MEDICAL CENTER |
Practice Address - City: | MURFREESBORO |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37130 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-251-2014 |
Practice Address - Fax: | 615-284-3854 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-07 |
Last Update Date: | 2010-07-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 1007 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3662699 | Medicare ID - Type Unspecified | |
TN | Q24768 | Medicare UPIN |