Basic Information
| Provider Information | |||||||||
| NPI: | 1164411286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMAR C RODRIGUEZ, M.D., PROFESSIONAL ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 847 | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670420847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163217683 | ||||||||
| FaxNumber: | 3163227750 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W CENTRAL AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | EL DORADO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670422184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163217683 | ||||||||
| FaxNumber: | 3163227750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | WILMAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3163217683 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 24390 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.