Provider Demographics
NPI:1063693398
Name:EKMARK, RODERICK D (MD)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:D
Last Name:EKMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:DAVID
Other - Last Name:EKMARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-1422
Mailing Address - Country:US
Mailing Address - Phone:830-581-8027
Mailing Address - Fax:830-244-0833
Practice Address - Street 1:101 WOODBRIDGE DR BLDG B
Practice Address - Street 2:STE 101 AND 102
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-0109
Practice Address - Country:US
Practice Address - Phone:830-581-8027
Practice Address - Fax:830-244-0833
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0974207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine