Basic Information
| Provider Information | |||||||||
| NPI: | 1891916854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODDY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 862565 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328862565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002481639 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 GLADES ROAD | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613624400 | ||||||||
| FaxNumber: | 5613654445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207L00000X | ME037881 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.