Provider Demographics
NPI:1659481430
Name:MUHAMMAD, RODNEY R (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:R
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RODNEY
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1728
Mailing Address - Country:US
Mailing Address - Phone:719-368-6628
Mailing Address - Fax:719-368-6629
Practice Address - Street 1:417 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1728
Practice Address - Country:US
Practice Address - Phone:719-368-6628
Practice Address - Fax:719-368-6629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052572207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05321875Medicaid
CO331374Medicare PIN