Healthcare Provider Details

I. General information

NPI: 1821088311
Provider Name (Legal Business Name): RODNEY LELAND COLDREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMC-AFRIMS
APO AP
96546
US

IV. Provider business mailing address

USAMC-AFRIMS
APO AP
96546
US

V. Phone/Fax

Practice location:
  • Phone: 666-049-0094
  • Fax:
Mailing address:
  • Phone: 666-049-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD052183L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: