EDMUNDO ALEJANDRO RODRIGUEZ (NPI# 1912117912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912117912 |
| Entity Type | Individual |
| Full Name | EDMUNDO ALEJANDRO RODRIGUEZ |
| Credential | MD |
| Practice Address |
6812 State Route 162 Suite 204 Maryville IL 62062 |
| Mailing Address |
6810 State Route 162 Maryville IL 62062 |
| Practice Telephone | 6183915070 |
| Practice Fax Number | 6182881872 |
| Mailing Telephone | 6184623200 |
| Mailing Fax Number | 6184635003 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
45630 | KY | Allopathic & Osteopathic Physicians |
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
036-120237 | IL | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | 036.120237 | IL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INSTITUTIONAL PERMIT | BP1-0022674 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Memorial Dr, Ste 2-101, Alton, IL 620026722 | 6184623200 | 6184635003 |
| Street Address |
6812 STATE ROUTE 162 SUITE 204 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447252978 | Brett R Grebing | Orthopaedic Surgery | 6812 State Route 162, Suite 123, Maryville, IL 62062 | 2005-08-15 |
| 1114454733 | Michael Barajas | Physician Assistant | 6812 State Route 162, Suite 120, Maryville, IL 62062-8553 | 2017-05-12 |
| 1043757867 | Alyssa Ruwe | Nurse Practitioner | 6812 State Route 162, Suite 123, Maryville, IL 62062-8553 | 2017-01-31 |
| 1689092132 | Alyssa Ryanne Goddard Verheyen | Nurse Practitioner | 6812 State Route 162, Suite 202, Maryville, IL 62062-8553 | 2014-04-02 |
| 1922348002 | Laura E. Mckinzie | Nurse Practitioner | 6812 State Route 162, Suite 21, Maryville, IL 62062-8553 | 2013-02-26 |
| 1053656298 | Alan Michael Meredith | Physician Assistant | 6812 State Route 162, Suite 21, Maryville, IL 62062 | 2012-11-28 |
| 1124261219 | Maryville Physicians Services Inc | Orthopaedic Surgery | 6812 State Route 162, Suite 123, Maryville, IL 62062-8553 | 2009-04-20 |
| 1942422498 | Ryan Diederich | Surgery | 6812 State Route 162, Maryville, IL 62062-8553 | 2007-05-03 |
| 1922159037 | Kevin Bradley Garner | Internal Medicine | 6812 State Route 162, Suite 204, Maryville, IL 62062-8553 | 2007-01-15 |
| 1700960572 | Rodney L. Greeling | Internal Medicine | 6812 State Route 162, Ste 21, Maryville, IL 62062 | 2006-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750364782 | William Elwyn Lyles | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2005-11-23 |
| 1922009943 | Mark Stephen Fedder | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2005-08-02 |
| 1245592823 | Isaac W Cline | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2012-06-11 |
| 1184806101 | Mark Fedder, Md, PC | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2007-11-30 |
| 1912115460 | Jenny Owens Smith | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2007-05-18 |
| 1306938048 | Ravindra Murthy | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2006-09-29 |
| 1144286709 | Blount Gastroenterology Assoc PC | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-24 |
| 1689638884 | Frank David Wright | Internal Medicine | 355 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2006-04-14 |
| 1225091564 | Michael John Coffey | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-08 |
| 1942263280 | Richard Glen Cline | Internal Medicine | 1706 E Lamar Alexander Pkwy, Maryville, TN 37804-6204 | 2006-04-08 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.