Provider Demographics
NPI:1619914363
Name:DILL, RODNEY SYDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:SYDNEY
Last Name:DILL
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 1:814 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-2124
Mailing Address - Country:US
Mailing Address - Phone:785-626-9434
Mailing Address - Fax:
Practice Address - Street 1:707 GRANT
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-0005
Practice Address - Country:US
Practice Address - Phone:785-626-3241
Practice Address - Fax:785-626-3188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17767208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB69080Medicare UPIN
KS104523Medicare ID - Type Unspecified