Provider Demographics
NPI:1649257270
Name:RODRIGUEZ, RUFUS (MD)
Entity type:Individual
Prefix:
First Name:RUFUS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16-03136OtherMEDICA
MN119872Medicaid
MN861S7ROOtherBLUE CROSS
MN861S7ROMedicaid
MN2055380OtherARAZ
MN38408OtherSIOUX VALLEY
MN9958OtherAVERA
MNMH9041013411OtherPREFERREDONE
IA584680Medicaid
MN695523100Medicaid
MNHP17646OtherHEALTHPARTNERS
MNMH9041013411OtherPREFERREDONE
MN119872Medicaid