Provider Demographics
NPI:1912930124
Name:AKING, RODD (MD)
Entity Type:Individual
Prefix:DR
First Name:RODD
Middle Name:
Last Name:AKING
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:PO BOX 12170
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-2170
Mailing Address - Country:US
Mailing Address - Phone:623-873-0112
Mailing Address - Fax:623-873-1370
Practice Address - Street 1:5251 W CAMPBELL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1715
Practice Address - Country:US
Practice Address - Phone:623-873-0112
Practice Address - Fax:623-873-1370
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35874Medicaid
AZ35879OtherLICENSE #