Provider Demographics
NPI:1124093893
Name:RODRIGUEZ, RONALD L (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
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 1:400 HOSPITAL DR STE 111
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:400 HOSPITAL DR STE 116
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-3820
Practice Address - Fax:903-641-3821
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167882303Medicaid
TX8W4543OtherBLUE CROSS
TX167882302Medicaid
TX8W4543OtherBLUE CROSS
I17442Medicare UPIN
TXP00414222Medicare PIN