Provider Demographics
NPI:1588631659
Name:MARCOM, RODNEY ALBERT (DO)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALBERT
Last Name:MARCOM
Suffix:
Gender:M
Credentials:DO
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 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:10240 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6203
Practice Address - Country:US
Practice Address - Phone:904-262-9204
Practice Address - Fax:904-390-7462
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82906OtherBLUE CROSS/BLUE SHIELD
FLD60764Medicare UPIN
FL82906OtherBLUE CROSS/BLUE SHIELD