Individual
MR. PAUL L RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4713 N PORTWEST CIR, WICHITA, KS 67204-2356
(316) 729-5517
(316) 729-5655
Mailing address
4713 N PORTWEST CIR, WICHITA, KS 67204-2356
(316) 729-5517
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10166
OK
2085R0202X
Diagnostic Radiology Physician
ME90262
FL
208D00000X
General Practice Physician
04-14664
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100206250B
—
OK
01
—
248522505
MEDICARE
OK
01
—
7016639
AETNA
OK
01
—
BCBS OF KS
BCBS IND OF KS 000105163
KS
01
—
P00272804
RR MEDICARE #
OK
Enumeration date
08/05/2006
Last updated
01/27/2016
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