Provider Demographics
NPI:1417927369
Name:ECHOLS, RODERICK EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:EVANS
Last Name:ECHOLS
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 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5652
Mailing Address - Fax:949-567-9827
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5220
Practice Address - Country:US
Practice Address - Phone:903-614-5110
Practice Address - Fax:903-614-5114
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11893207R00000X
TXM3213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163718001Medicaid
OK200104510AMedicaid
AR84034OtherBCBS ARKANSAS
TX182971501Medicaid
TX8V4240OtherBCBS-TEXAS
TXP00351803OtherRR MEDICARE
TX182971501Medicaid
OK200104510AMedicaid
TXP00351803Medicare PIN