Provider Demographics
NPI:1518912963
Name:RODNING, CHARLES B (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:RODNING
Suffix:
Gender:M
Credentials:MD, PHD
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MASTIN 101
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-445-8282
Practice Address - Fax:251-445-8281
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009939OtherBLUE CROSS
AL000009939Medicaid
MS00010801Medicaid
FL055204600Medicaid
AL17-10305OtherUNITED HEALTH CARE
MS00010801Medicaid
FL055204600Medicaid
AL51009939OtherBLUE CROSS