Provider Demographics
NPI:1528072014
Name:VERGEL DE DIOS, RODERICK VILLAROMAN (MD)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:VILLAROMAN
Last Name:VERGEL DE DIOS
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 1:5105 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2331
Mailing Address - Country:US
Mailing Address - Phone:956-686-6644
Mailing Address - Fax:956-467-1010
Practice Address - Street 1:5105 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2331
Practice Address - Country:US
Practice Address - Phone:956-686-6644
Practice Address - Fax:956-467-1010
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK 1713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXEPSD49990Medicaid
TX126632205OtherMEDICAID EPSDT PROV. NUMB
TXMIXEDOtherCOMMERCIAL INS. PROV NO.
TX126632202Medicaid
TX5805616OtherAETA PIN
TXA002OtherTRICARE PIN
TXA001OtherCHAMPUS
TX116761OtherSUPERIOR HEALTH PIN
TX0021DFOtherBLUE CROSS PROVIDER NUMBE
TX080145415OtherMEDICARE RAILROAD PIN
TX116761OtherSUPERIOR HEALTH PIN
TX126632202Medicaid