Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35083261 | OH |
N | 207QS0010X | Family Doctor - Sports Medicine | 35083261 | OH |
N | 207R00000X | Internist | 35083261 | OH |
N | 111NI0900X | Internist | 35083261 | OH |
N | 208000000X | Pediatrician | 35083261 | OH |
NPI | 1205811932 |
---|---|
Provider Name | Richard Edward Rodenberg JR. |
First Address | Columbus, OH 43205-2664 |
Second Address | Dublin, OH 43017-2190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 21/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2464391 | (05) | OH |