Provider Demographics
NPI:1679503155
Name:RODRIGUEZ, RUDOLPH ALBERT (MD)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:ALBERT
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 1:1660 S COLUMBIAN WAY RM 229
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-3282
Mailing Address - Fax:206-764-2903
Practice Address - Street 1:1660 S COLUMBIAN WAY RM 229
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-3282
Practice Address - Fax:206-764-2903
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047865207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110146812OtherRAILROAD MEDICARE
CA00G698250Medicaid
CA00G698250Medicaid