Provider Demographics
NPI:1588765879
Name:ROHRDANZ, DAVID I (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:ROHRDANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0410011OtherCIGNA
CA1089823OtherGREAT WEST
CA000810342874OtherPHCS
CA021567OtherHEALTH NET
CAMCMG126100OtherWESTERN HEALTH ADVANTAGE
CAOOG498430Medicaid
CAG49843OtherBLUE CROSS
CA1454476OtherUNITED HEALTHCARE
CA1062637OtherFIRST HEALTH
CA16074OtherINTERPLAN
CA4052676OtherAETNA
CA90026162OtherPACIFICARE
CA0410011OtherCIGNA
CA90026162OtherPACIFICARE