Provider Demographics
NPI:1215092689
Name:CHARLES J. RODMAN, MD PA
Entity type:Organization
Organization Name:CHARLES J. RODMAN, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-832-8323
Mailing Address - Street 1:#7 BAYOUBRANDT
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2618
Mailing Address - Country:US
Mailing Address - Phone:409-832-8323
Mailing Address - Fax:409-832-4881
Practice Address - Street 1:#7 BAYOUBRANDT
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2618
Practice Address - Country:US
Practice Address - Phone:409-832-8323
Practice Address - Fax:409-832-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE34232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00280ZMedicare ID - Type Unspecified
TX8F0814Medicare PIN