Individual
JONATHAN R RODDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 COLLEGE DR, ROCK SPRINGS, WY 82901-5868
(307) 352-8350
(307) 352-8178
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6643A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116306000
—
WY
01
—
315393
BSWY
WY
01
—
605960009
FBL
WY
Enumeration date
12/14/2006
Last updated
12/01/2021
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