Provider Demographics
NPI:1770792442
Name:HINDS, RODNEY A (PA)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:HINDS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8426
Mailing Address - Country:US
Mailing Address - Phone:541-789-4096
Mailing Address - Fax:541-789-4073
Practice Address - Street 1:750 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8426
Practice Address - Country:US
Practice Address - Phone:541-789-4096
Practice Address - Fax:541-789-4073
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS61211Medicare UPIN