Provider Demographics
NPI:1184962649
Name:STEINEM, RODGER HOWARD
Entity type:Individual
Prefix:MR
First Name:RODGER
Middle Name:HOWARD
Last Name:STEINEM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RODGER
Other - Middle Name:HOWARD
Other - Last Name:STEINEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:5501 W MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4811
Mailing Address - Country:US
Mailing Address - Phone:720-275-5425
Mailing Address - Fax:
Practice Address - Street 1:5501 W MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4811
Practice Address - Country:US
Practice Address - Phone:720-275-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003577363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical