Provider Demographics
NPI:1275788630
Name:ST. CLAIR, RODMAN A (MD)
Entity Type:Individual
Prefix:
First Name:RODMAN
Middle Name:A
Last Name:ST. CLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 E GUASTI RD STE 700
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7643
Mailing Address - Country:US
Mailing Address - Phone:909-605-8015
Mailing Address - Fax:866-929-7385
Practice Address - Street 1:3281 E GUASTI RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7622
Practice Address - Country:US
Practice Address - Phone:909-605-8015
Practice Address - Fax:866-929-7385
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine