Provider Demographics
NPI:1104075290
Name:BRUNET RODRIGUEZ, HECTOR (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:BRUNET RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HECTOR
Other - Middle Name:
Other - Last Name:BRUNET RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 750
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3939
Mailing Address - Fax:318-212-3965
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 750
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3939
Practice Address - Fax:318-212-3965
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17860390200000X
LAMD206140207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17860OtherSTATE LICENSE