Basic Information
| Provider Information | |||||||||
| NPI: | 1124093893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HOSPITAL DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414895 | ||||||||
| FaxNumber: | 9036414894 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HOSPITAL DR STE 116 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036413820 | ||||||||
| FaxNumber: | 9036413821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L8176 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 167882303 | 05 | TX | MEDICAID | 8W4543 | 01 | TX | BLUE CROSS | OTHER | 167882302 | 05 | TX | MEDICAID |