Provider Demographics
NPI:1093749913
Name:ROODE, TERRY DEAN (DO)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DEAN
Last Name:ROODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:03920 SOUTHLAND RD.
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-0127
Mailing Address - Country:US
Mailing Address - Phone:419-629-2772
Mailing Address - Fax:419-629-3613
Practice Address - Street 1:03920 SOUTHLAND RD.
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-0127
Practice Address - Country:US
Practice Address - Phone:419-629-2772
Practice Address - Fax:419-629-3613
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003323207Q00000X
OH34-00-3323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH084151OtherPTAN
OH0488600Medicaid
OH0995811Medicaid
OH1801976311OtherGROUP NPI
OH1417992710OtherGROUP NPI
OH0995811Medicaid
OHA15109Medicare UPIN