Individual
JESSE STEVEN RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 BUNTON CREEK RD, SUITE 100, KYLE, TX 78640-5787
(512) 268-2068
Mailing address
PO BOX 938, KILLEEN, TX 76540-0938
(254) 245-9045
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K7384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031467620
—
TX
01
—
TXB152460
PTAN
TX
Enumeration date
05/17/2006
Last updated
10/29/2013
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