Provider Demographics
NPI:1003046426
Name:RODAKOWSKI, JOHN L (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:RODAKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-495-3244
Mailing Address - Fax:360-495-3364
Practice Address - Street 1:322 S. BIRCH STREET
Practice Address - Street 2:
Practice Address - City:MCCLEARLY
Practice Address - State:WA
Practice Address - Zip Code:98557-9522
Practice Address - Country:US
Practice Address - Phone:360-495-3244
Practice Address - Fax:360-495-3364
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60096761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine