Provider Demographics
NPI:1134201312
Name:RODIER, FRCPC,INC, ERNEST STANLEY (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:STANLEY
Last Name:RODIER, FRCPC,INC
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 1:15725 POMERADO ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:858-485-8111
Mailing Address - Fax:858-485-9926
Practice Address - Street 1:15725 POMERADO ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-485-8111
Practice Address - Fax:858-485-9926
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33957207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45735Medicare UPIN
CA05D0567299Medicare ID - Type Unspecified