Provider Demographics
NPI:1083069793
Name:RODEBACK, DAMION D (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAMION
Middle Name:D
Last Name:RODEBACK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1034
Mailing Address - Country:US
Mailing Address - Phone:801-704-7001
Mailing Address - Fax:801-806-0383
Practice Address - Street 1:1449 N 1400 W STE 22
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5237
Practice Address - Country:US
Practice Address - Phone:435-703-9296
Practice Address - Fax:435-215-4075
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54658207N00000X, 363A00000X
WAPA60677483363AS0400X
UT65833191206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical