Provider Demographics
NPI:1124094628
Name:RODRIGUEZ, EDGAR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935-0429
Mailing Address - Country:US
Mailing Address - Phone:210-213-2880
Mailing Address - Fax:
Practice Address - Street 1:1363 ABERDEEN AVENUE
Practice Address - Street 2:
Practice Address - City:WHITE SANDS MISSILE RANGE
Practice Address - State:NM
Practice Address - Zip Code:88002
Practice Address - Country:US
Practice Address - Phone:575-674-3500
Practice Address - Fax:915-742-7459
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11644207Q00000X, 2083A0100X, 2083X0100X
NMMD2024-0814207Q00000X, 2083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine