Provider Demographics
NPI:1972744712
Name:RODOCKER, JOSHUA AARON (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:AARON
Last Name:RODOCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CUNNINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8339
Mailing Address - Country:US
Mailing Address - Phone:859-936-3511
Mailing Address - Fax:
Practice Address - Street 1:2400 GREATSTONE POINT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8339
Practice Address - Country:US
Practice Address - Phone:859-323-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN/A208000000X, 2084P0800X
KY034552084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100249930Medicaid
KY7100249930Medicaid