Provider Demographics
NPI:1487818811
Name:RODRIGUEZ, ANGEL A (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:A
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 1:9715 BURNET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5390
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-334-2702
Practice Address - Street 1:900 W 38TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1128
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:512-334-2702
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9874207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194797010Medicaid
TX1487818811OtherBLUE CROSS BLUE SHIELD
TX194797005Medicaid
TX8EE777OtherBLUE CROSS BLUE SHIELD
TX194797006Medicaid
TX194797009Medicaid
TX8CS218OtherBLUE CROSS BLUE SHIELD
TX194797008Medicaid
TX194797007Medicaid
TX346482ZSWDMedicare PIN
TX8EE777OtherBLUE CROSS BLUE SHIELD
TX194797008Medicaid
TX1487818811OtherBLUE CROSS BLUE SHIELD
TX194797010Medicaid
TX8L0125Medicare PIN
TXTXB158541Medicare PIN