Provider Demographics
NPI:1568458800
Name:BAHNER, RODERICK I SR (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:I
Last Name:BAHNER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:STE 370
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-865-5830
Practice Address - Fax:615-865-5831
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-01-21
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Provider Licenses
StateLicense IDTaxonomies
TNMD07205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1502881Medicaid
TN1502881Medicaid
103I379699Medicare Oscar/Certification