Individual
JEREMY BOYD RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
13271 BASS PRO DR STE 140, COLORADO SPRINGS, CO 80921-3828
(888) 663-6331
(415) 252-7176
Mailing address
1 EMBARCADERO CTR STE 1900, SAN FRANCISCO, CA 94111-3723
(888) 663-6331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
59269
CO
207Q00000X
Family Medicine Physician
6551
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088530B
—
KS
Enumeration date
05/01/2007
Last updated
03/14/2025
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