Provider Demographics
NPI:1699726232
Name:STODDARD, RODNEY (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:STODDARD
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:PO BOX 7387
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0013
Mailing Address - Country:US
Mailing Address - Phone:480-874-7014
Mailing Address - Fax:480-874-7014
Practice Address - Street 1:111 S 11TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3242
Practice Address - Country:US
Practice Address - Phone:509-575-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029274207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF49261Medicare UPIN
WAG8851420Medicare PIN