Provider Demographics
NPI:1184865172
Name:RODI, JAKE JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:JOSEPH
Last Name:RODI
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 1:7772 BELLE CHASSE HWY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2060
Mailing Address - Country:US
Mailing Address - Phone:504-371-9370
Mailing Address - Fax:504-371-9383
Practice Address - Street 1:7772 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2060
Practice Address - Country:US
Practice Address - Phone:504-371-9370
Practice Address - Fax:504-371-9383
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204199207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05732276Medicaid
LA1983373Medicaid
LA4R2347061Medicare PIN