John L Rodakowski, M.D.
Individual provider Active NPI Family Medicine Physician · McClearly, WA
NPI 1003046426 · NPPES record last updated Jan 24, 2013
Key facts
- NPI
- 1003046426
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ML60096761 (WA)
- Practice address
- 322 S. Birch Street
McClearly, WA 98557-9522 - Phone
- (360) 495-3244
- Fax
- (360) 495-3364
- NPI assigned
- Jul 20, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ML60096761 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grays Harbor County Public Hospital District No 1 | Current | Accepting new patients |
Locations
600 E Main St
Elma, WA 98541
Phone (360) 346-2222
Interoperability endpoints
- jrodako000@direct.sp-mc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ML60096761 | WA | Yes |
Addresses
Primary practice location
322 S. Birch Street
McClearly, WA 98557-9522
Mailing address
600 E. Main Street
Elma, WA 98541
Phone (360) 495-3244
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.