Provider Demographics
NPI:1730123597
Name:RODEN, CHRISTOPHER DUANE (SAPAC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DUANE
Last Name:RODEN
Suffix:
Gender:M
Credentials:SAPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1134
Mailing Address - Country:US
Mailing Address - Phone:256-492-8590
Mailing Address - Fax:256-492-4498
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1134
Practice Address - Country:US
Practice Address - Phone:256-492-8590
Practice Address - Fax:256-492-4498
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51002699OtherBCBS AL
Q51874Medicare UPIN
51556674Medicare ID - Type Unspecified