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NPI Code Detail

MEDICARE: DR. CHRISTOPHER JEFFREY CHARLES RODGMAN M.D.

MEDICARE: DR. CHRISTOPHER JEFFREY CHARLES RODGMAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry PhysicianMD.205436LA

General Provider Information

NPI Number : 1861635849
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER JEFFREY CHARLES RODGMAN M.D.
Provider Business Mailing Address
First Line : PO BOX 53709
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-3709
Country : US
Telephone Number : 877-294-7247
Fax Number : 866-990-8296
Provider Business Practice Location Address
First Line : 44 VERSAILLES BLVD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3960
Country : US
Telephone Number : 318-445-5111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2009
Last Update Date : 12/28/2020

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