Provider Demographics
NPI:1861521411
Name:RODRIGUEZ, HECTOR MANUEL (DO)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:MANUEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SW VERMONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1945
Mailing Address - Country:US
Mailing Address - Phone:503-977-9838
Mailing Address - Fax:503-977-9624
Practice Address - Street 1:1820 SW VERMONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-977-9838
Practice Address - Fax:503-977-9624
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR063235Medicaid
ORK867001OtherPACIFIC SOURCE
OR4525022OtherAETNA
0071287OtherWASHINGTON DEPT L & I
OR1699495OtherCIGNA
ORM5745OtherHEALTHNET OF OREGON
OR302840OtherPROVIDENCE HEALTH PLAN
OR0001424435OtherHIGHMARK BCBS
0071287OtherWASHINGTON DEPT L & I
ORM5745OtherHEALTHNET OF OREGON