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NPI Code Detail

MEDICARE: DR. RODNEY MARK SAMUELSON MD

MEDICARE: DR. RODNEY MARK SAMUELSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207T00000XNeurological Surgery Physician50883CO
2207T00000XNeurological Surgery Physician9575SD

General Provider Information

NPI Number : 1083875744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODNEY MARK SAMUELSON MD
Provider Business Mailing Address
First Line : 353 FAIRMONT BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7375
Country : US
Telephone Number : 605-755-8107
Fax Number :
Provider Business Practice Location Address
First Line : 1635 CAREGIVER CIR
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-8529
Country : US
Telephone Number : 605-755-6100
Fax Number : 605-755-6101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2008
Last Update Date : 02/28/2020

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