Provider Demographics
NPI:1093795304
Name:RODGERS, JODY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JODY
Other - Middle Name:A
Other - Last Name:KROSNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 SAINT MARYS MEDICAL PLZ
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1604
Mailing Address - Country:US
Mailing Address - Phone:573-636-9000
Mailing Address - Fax:573-635-2656
Practice Address - Street 1:200 SAINT MARYS MEDICAL PLZ
Practice Address - Street 2:SUITE 301
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1604
Practice Address - Country:US
Practice Address - Phone:573-636-9000
Practice Address - Fax:573-635-2656
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109997208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCN2273OtherRAILROAD GROUP
MO208217711Medicaid
MO112892OtherBCBS
MO240005438OtherPALMETTO
MO293232OtherHEALTHLINK
MO208217711Medicaid
MO040645435Medicare PIN
MO112892OtherBCBS