Provider Demographics
NPI:1679303432
Name:DE MELO RODRIGUES, RODOLFO MYRONN (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO MYRONN
Middle Name:
Last Name:DE MELO RODRIGUES
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 1:2000 B TRANSMOUNTAIN ROAD
Mailing Address - Street 2:MOB ROOM B318 MSC 42001
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911
Mailing Address - Country:US
Mailing Address - Phone:915-215-5730
Mailing Address - Fax:915-215-8671
Practice Address - Street 1:2000 B TRANSMOUNTAIN ROAD
Practice Address - Street 2:MOB ROOM B318 MSC 42001
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:915-215-5730
Practice Address - Fax:915-215-8671
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10091217390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program