Provider Demographics
NPI:1275511586
Name:ANDERSON, RODNEY J (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:J
Last Name:ANDERSON
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 1:1300 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4453
Mailing Address - Country:US
Mailing Address - Phone:317-968-0409
Mailing Address - Fax:317-968-0402
Practice Address - Street 1:1300 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4453
Practice Address - Country:US
Practice Address - Phone:317-968-0409
Practice Address - Fax:317-968-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000697A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN203669845OtherFEDERAL TAX ID
IN000000387137OtherANTHEM BLUE CROSS AND BLU
IN7402585OtherAETNA
IN000000387137OtherICHIA
IN200260200 BMedicaid
IN000000387137OtherANTHEM BLUE CROSS AND BLU
IN7402585OtherAETNA
IN234430Medicare PIN