Provider Demographics
NPI:1912175209
Name:MCDOWELL, RODDY D JR (MD)
Entity Type:Individual
Prefix:
First Name:RODDY
Middle Name:D
Last Name:MCDOWELL
Suffix:JR
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 1:916 DUPONT ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-454-7107
Mailing Address - Fax:502-454-0347
Practice Address - Street 1:916 DUPONT ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-454-7107
Practice Address - Fax:502-454-0347
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY415582080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100068900Medicaid
IN200886820Medicaid