Provider Demographics
NPI:1356314223
Name:DYNES, RODNEY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:WAYNE
Last Name:DYNES
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 338
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-0338
Mailing Address - Country:US
Mailing Address - Phone:507-831-3388
Mailing Address - Fax:507-831-4170
Practice Address - Street 1:820 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1761
Practice Address - Country:US
Practice Address - Phone:507-831-3388
Practice Address - Fax:507-831-4170
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN224703800Medicaid
080169739OtherRAILROAD MEDICARE
MN224703800Medicaid
080010077Medicare PIN