Provider Demographics
NPI:1316047574
Name:RODRIGUEZ, RAUL A JR (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:617 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9636
Mailing Address - Country:US
Mailing Address - Phone:509-422-5685
Mailing Address - Fax:
Practice Address - Street 1:617 BENTON ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9636
Practice Address - Country:US
Practice Address - Phone:509-422-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine