Provider Demographics
NPI:1003874439
Name:BADGER, RODNEY S (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:S
Last Name:BADGER
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 1:2490 S WOODWORTH LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7410
Mailing Address - Country:US
Mailing Address - Phone:907-861-6700
Mailing Address - Fax:907-861-6705
Practice Address - Street 1:2490 S WOODWORTH LOOP STE 250
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7407
Practice Address - Country:US
Practice Address - Phone:907-861-6700
Practice Address - Fax:907-861-6705
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT42342207RC0000X
UT1856111205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870281028BA1OtherEMIA
UT107005669101OtherIHC HEALTHPLANS
UT6198OtherDMBA
UT25-00152OtherUNITED HEALTHCARE
UTQM0000001562OtherALTIUS
UT870281028000Medicaid
UT26618OtherPEHP
UT6198OtherDMBA
UTA52735Medicare UPIN