Provider Demographics
NPI:1598750861
Name:SYATA, RHONDA LYNN DODGE (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN DODGE
Last Name:SYATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:L
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:909 SW ORALABOR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7004
Mailing Address - Country:US
Mailing Address - Phone:515-963-4400
Mailing Address - Fax:515-964-9838
Practice Address - Street 1:909 SW ORALABOR RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7004
Practice Address - Country:US
Practice Address - Phone:515-963-4400
Practice Address - Fax:515-964-9838
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1598750861Medicaid
I13011OtherMEDICARE
IA0432682Medicaid
I13011OtherMEDICARE
I16129Medicare UPIN