Provider Demographics
NPI:1720327810
Name:ROD TODD MD PC
Entity type:Organization
Organization Name:ROD TODD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-672-0497
Mailing Address - Street 1:2282 NW TROOST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6072
Mailing Address - Country:US
Mailing Address - Phone:541-672-0497
Mailing Address - Fax:541-957-2663
Practice Address - Street 1:2282 NW TROOST ST STE 103
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6072
Practice Address - Country:US
Practice Address - Phone:541-672-0497
Practice Address - Fax:541-957-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty