Provider Demographics
NPI:1053326702
Name:RODRICK D MCKINLAY MD PC
Entity Type:Organization
Organization Name:RODRICK D MCKINLAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKINLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-3800
Mailing Address - Street 1:1521 E 3900 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1550
Mailing Address - Country:US
Mailing Address - Phone:801-268-3800
Mailing Address - Fax:801-268-3997
Practice Address - Street 1:1521 E 3900 S STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1550
Practice Address - Country:US
Practice Address - Phone:801-268-3800
Practice Address - Fax:801-268-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty