Provider Demographics
NPI:1568273639
Name:CASE, RODNEY SCOTT
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:SCOTT
Last Name:CASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 FINK ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4347
Mailing Address - Country:US
Mailing Address - Phone:408-963-1485
Mailing Address - Fax:
Practice Address - Street 1:155 S EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3374
Practice Address - Country:US
Practice Address - Phone:541-756-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3885175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist