Basic Information
| Provider Information | |||||||||
| NPI: | 1588738405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | ROD | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 548 OCEAN ST | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950606602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314233196 | ||||||||
| FaxNumber: | 8314230755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1343 US HIGHWAY 93 N | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599179503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973915 | ||||||||
| FaxNumber: | 4062973919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | CA9485 | CA | Y | Other Service Providers | Specialist | 174400000X | 2476PT | MT | N | Other Service Providers | Specialist |
No ID Information.