Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 50883 | CO |
Y | 207T00000X | Neurosurgeon | 9575 | SD |
NPI | 1083875744 |
---|---|
Provider Name | Dr. Rodney Mark Samuelson |
First Address | Rapid City, SD 57701-7375 |
Second Address | Rapid City, SD 57702-8529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 28/02/2020 |