Basic Information
| Provider Information | |||||||||
| NPI: | 1063693398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EKMARK | ||||||||
| FirstName: | RODERICK | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EKMARK | ||||||||
| OtherFirstName: | R. | ||||||||
| OtherMiddleName: | DAVID | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 499 10TH ST. | ||||||||
| Address2: | |||||||||
| City: | FLORESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931300 | ||||||||
| FaxNumber: | 8303931301 | ||||||||
| Practice Location | |||||||||
| Address1: | 13857 US HIGHWAY 87 WEST | ||||||||
| Address2: | |||||||||
| City: | LA VERNIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931400 | ||||||||
| FaxNumber: | 8307792760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 036124483 | IL | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | P0974 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.