Healthcare Provider Details

I. General information

NPI: 1477559383
Provider Name (Legal Business Name): MATTHEW RODE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 NW CROSSING DR SUITE 102
BEND OR
97701-7049
US

IV. Provider business mailing address

2855 NW CROSSING DR SUITE 102
BEND OR
97701-7049
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-8066
  • Fax: 541-383-3066
Mailing address:
  • Phone: 541-383-8066
  • Fax: 541-383-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD25248
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: