Individual
GONZALO J RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3130 N COUNTY ROAD 25A STE 212, TROY, OH 45373
(937) 335-1660
(937) 440-4020
Mailing address
3170 KETTERING BLVD BLDG B3, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01079320A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
35.069702
OH
207V00000X
Obstetrics & Gynecology Physician
4301067013
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236040248
MEDICARE PTAN
IN
05
—
300007805
—
IN
Enumeration date
01/19/2006
Last updated
06/24/2021
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