Provider Demographics
NPI:1124826284
Name:RODGERS, LEON EDWARD II
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:EDWARD
Last Name:RODGERS
Suffix:II
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2580
Mailing Address - Country:US
Mailing Address - Phone:614-866-5456
Mailing Address - Fax:
Practice Address - Street 1:491 GEORGESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2420
Practice Address - Country:US
Practice Address - Phone:614-618-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR865221172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker