Individual
GARY D RODEWALD
Active
Individual
GARY D RODEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN22190
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255385787
—
ID
05
—
1255385787
—
MT
01
—
M000009917
MEDICARE GROUP
MT
Enumeration date
05/20/2006
Last updated
11/05/2015
Update your record
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