Provider Demographics
NPI:1417191974
Name:RODRIGUEZ, ERIK WILLIAM (IDMT)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:WILLIAM
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PURPLE MARTIN PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8262
Mailing Address - Country:US
Mailing Address - Phone:478-997-1343
Mailing Address - Fax:
Practice Address - Street 1:106 PURPLE MARTIN PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8262
Practice Address - Country:US
Practice Address - Phone:478-997-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians