Provider Demographics
NPI:1215912613
Name:RODRIGUEZ, JUAN ANTONIO JR (MDW)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MDW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 142487
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2487
Mailing Address - Country:US
Mailing Address - Phone:787-898-3517
Mailing Address - Fax:787-898-3517
Practice Address - Street 1:CARRET. #2 KM 86.7
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-3517
Practice Address - Fax:787-898-3517
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11193207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41719Medicare UPIN
87946Medicare ID - Type Unspecified