Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | N4706 | TX |
N | 207PP0204X | Pediatric Emergency Physician | N4706 | TX |
NPI | 1508803289 |
---|---|
Provider Name | Mark L Rodkey |
First Address | Gates Mills, OH 44040-9712 |
Second Address | Mayfield Hts, OH 44124-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 12/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0968145 | (05) | OH |
942460636138 | CARESOURCE (01) | OH |
F77857 | (02) | OH |