Provider Demographics
NPI:1407806078
Name:RODGMAN, GRAEME M (MD)
Entity Type:Individual
Prefix:
First Name:GRAEME
Middle Name:M
Last Name:RODGMAN
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 1:3520 LAKIN AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3646
Mailing Address - Country:US
Mailing Address - Phone:620-792-3345
Mailing Address - Fax:620-792-3767
Practice Address - Street 1:3520 LAKIN AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3646
Practice Address - Country:US
Practice Address - Phone:620-792-3345
Practice Address - Fax:620-792-3767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF88059Medicare UPIN
KS103327Medicare ID - Type Unspecified