Basic Information
| Provider Information | |||||||||
| NPI: | 1457390056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1177 | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749531177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186353100 | ||||||||
| FaxNumber: | 9186353398 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 WALL ST | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749534433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186353100 | ||||||||
| FaxNumber: | 9186353398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 3524 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.