Provider Demographics
NPI:1154412005
Name:CANOS, RODOLFO JASON IV (DO)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:JASON
Last Name:CANOS
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:12621 ECKEL JUNCTION RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1304
Mailing Address - Country:US
Mailing Address - Phone:419-724-4777
Mailing Address - Fax:419-724-4776
Practice Address - Street 1:12621 ECKEL JUNCTION RD STE 2800
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1304
Practice Address - Country:US
Practice Address - Phone:419-724-4777
Practice Address - Fax:419-724-4776
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34-00-8855208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery