Provider Demographics
NPI:1194823153
Name:POETTER, RODNEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:A
Last Name:POETTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:VIOLET
Other - Middle Name:D
Other - Last Name:POETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3002 SE 1ST AVE
Mailing Address - Street 2:#200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-351-5522
Mailing Address - Fax:352-351-2950
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:#200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-351-5522
Practice Address - Fax:352-351-2950
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174637268OtherGROUP NPI NUMBER
FL21827OtherBCBS GROUP
75184OtherBCBS INDIV
1194823153OtherNPI INDIV
FLMEDICAREMedicare UPIN
FLK0069Medicare ID - Type UnspecifiedGROUP #