Basic Information
| Provider Information | |||||||||
| NPI: | 1700447521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 N PARKWAY | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383053185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314220213 | ||||||||
| FaxNumber: | 7314255783 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380082201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316582885 | ||||||||
| FaxNumber: | 7316582886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2019 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 66166 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.