| Doctor Name: | DR. ANTONIO ENRIQUE RODRIGUEZ |
| NPI Number: | 1780657379 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 11611 |
| Business Practice Address: | 100 Brewster Blvd Psc Box 322 Camp Lejeune, NC - 285472538 |
| Business Phone Number: | 9104504520 |
| Business Fax Number: | |
| Mailing Address: | 100 Brewster Blvd, Psc Box 322 CAMP LEJEUNE |
| State: | NC |
| Postal Code: | 285472538 |
| Phone Number: | 9104504520 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2006 |
| NPI Last Update Date: | 12/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 11611 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| 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. |