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RODNEY D VITOVSKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
800 5TH AVE STE 500, FORT WORTH, TX 76104-7304
(817) 250-4280
Mailing address
800 5TH AVE STE 500, FORT WORTH, TX 76104-7304
(817) 250-4280

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA02563
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8N8272
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/17/2006
Last updated
03/09/2021
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