Healthcare Provider Details

I. General information

NPI: 1972744712
Provider Name (Legal Business Name): JOSHUA AARON RODOCKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE POINT
LEXINGTON KY
40536-8339
US

IV. Provider business mailing address

400 CUNNINGHAM WAY
DANVILLE KY
40422-8339
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5962
  • Fax:
Mailing address:
  • Phone: 859-936-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN/A
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberN/A
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number03455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: