Provider Demographics
NPI:1669686259
Name:BIRNEY, RODNEY S (MD)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:S
Last Name:BIRNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:BIRNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0763
Mailing Address - Country:US
Mailing Address - Phone:541-535-3338
Mailing Address - Fax:541-535-3338
Practice Address - Street 1:9820 WAGNER CREEK RD
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-7803
Practice Address - Country:US
Practice Address - Phone:541-535-3338
Practice Address - Fax:541-535-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
75-3080408OtherEIN
ORR109286Medicare PIN
75-3080408OtherEIN