Provider Demographics
NPI:1477559383
Name:RODE, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:RODE
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 1:2855 NW CROSSING DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7049
Mailing Address - Country:US
Mailing Address - Phone:541-383-8066
Mailing Address - Fax:541-383-3066
Practice Address - Street 1:2855 NW CROSSING DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7049
Practice Address - Country:US
Practice Address - Phone:541-383-8066
Practice Address - Fax:541-383-3066
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023077Medicaid
ORI30029Medicare UPIN
OR138253Medicare PIN