Provider Demographics
NPI:1316030380
Name:RODENHUIS, ROGER (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:RODENHUIS
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:PO BOX 7909
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75607-7909
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:817-516-8444
Practice Address - Street 1:SL57 LAKE CHEROKEE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652
Practice Address - Country:US
Practice Address - Phone:817-516-8811
Practice Address - Fax:817-516-8444
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264322700Medicaid
DCP00053082OtherRAILROAD MEDICARE
FL29047OtherBLUE CROSS BLUE SHIELD
DCP00053082OtherRAILROAD MEDICARE