| Doctor Name: | MR. EDGAR OMAR RODRIGUEZ |
| NPI Number: | 1093913402 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RDH |
| License Number: | 7920 |
| Business Practice Address: | Uss Bataan Lhd-5 Fpo Ae Norfolk, VA - 095541657 |
| Business Phone Number: | 7574456344 |
| Business Fax Number: | |
| Mailing Address: | 20290 Apricot Ln, CALDWELL |
| State: | ID |
| Postal Code: | 836079480 |
| Phone Number: | 2086027014 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 7920 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |