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General NPI Number Information
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NPI Number | 1164999132
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Entity Type | Individual
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Provider Name | CHRISTIAN ROEDER
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Gender | Male
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 2020 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4604
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Country | US
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Telephone | 941-792-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 855 N VILLAGE DR N
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City | ST PETERSBURG
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State | FL
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Zip | 33716-3056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN9304212
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License Number State | FL
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