Basic Information
| Provider Information | |||||||||
| NPI: | 1023057668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11449 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189622442 | ||||||||
| FaxNumber: | 9189623895 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 W BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | SPIRO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749592430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189622442 | ||||||||
| FaxNumber: | 9189623895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3525 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100256710A | 05 | OK | MEDICAID | 138645003 | 05 | AR | MEDICAID |