Provider Demographics
NPI:1366586190
Name:RODRIGUEZ, ABELARDO (MD)
Entity type:Individual
Prefix:
First Name:ABELARDO
Middle Name:
Last Name:RODRIGUEZ
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 1:8527 VILLAGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5513
Mailing Address - Country:US
Mailing Address - Phone:210-653-2693
Mailing Address - Fax:210-590-6075
Practice Address - Street 1:8527 VILLAGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5513
Practice Address - Country:US
Practice Address - Phone:210-653-2693
Practice Address - Fax:210-590-6075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092704801Medicaid
C21202Medicare UPIN
00BH46Medicare ID - Type Unspecified