Provider Demographics
NPI:1952691891
Name:RODDENBERRY, ROBERT COOK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COOK
Last Name:RODDENBERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:472 RANKIN DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6568
Mailing Address - Country:US
Mailing Address - Phone:828-659-5700
Mailing Address - Fax:828-659-5700
Practice Address - Street 1:189 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:828-766-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01668208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCY902AOtherMEDICARE