Healthcare Provider Details

I. General information

NPI: 1356314223
Provider Name (Legal Business Name): RODNEY WAYNE DYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 2ND AVE N
WINDOM MN
56101-1761
US

IV. Provider business mailing address

PO BOX 338
WINDOM MN
56101-0338
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-3388
  • Fax: 507-831-4170
Mailing address:
  • Phone: 507-831-3388
  • Fax: 507-831-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33684
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: