Provider Demographics
NPI:1174602668
Name:CANOS, RODOLFO J JR (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:J
Last Name:CANOS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0743
Mailing Address - Country:US
Mailing Address - Phone:740-532-0220
Mailing Address - Fax:740-532-5088
Practice Address - Street 1:1920 SOUTH 9TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-0743
Practice Address - Country:US
Practice Address - Phone:740-532-0220
Practice Address - Fax:740-532-5088
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35496207Q00000X
KY21219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212988Medicaid
KY64212194Medicaid
D31927Medicare UPIN
OH0212988Medicaid
KY64212194Medicaid