Provider Demographics
NPI:1316903404
Name:RODRIGUEZ, RICHARD AARON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:AARON
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PALO ALTO RD STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3782
Mailing Address - Country:US
Mailing Address - Phone:210-922-0555
Mailing Address - Fax:
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 450
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3772
Practice Address - Country:US
Practice Address - Phone:210-922-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1946174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082620801Medicaid
TX00FX74Medicare ID - Type UnspecifiedSTOA MC #
TX082620801Medicaid
TXC21200Medicare UPIN