Provider Demographics
NPI:1659351187
Name:ENGEL, RODNEY A (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:ENGEL
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 1:77 W FOREST AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-773-2547
Mailing Address - Fax:928-773-2548
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-773-2547
Practice Address - Fax:928-773-2548
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36012207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ340466Medicaid
AZP00624786OtherRAILROAD MEDICARE
AZZ122361Medicare PIN