Provider Demographics
NPI:1861181364
Name:RODERICK D. EKMARK, MD, PA
Entity type:Organization
Organization Name:RODERICK D. EKMARK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:EKMARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-581-8027
Mailing Address - Street 1:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-1422
Mailing Address - Country:US
Mailing Address - Phone:830-216-3121
Mailing Address - Fax:
Practice Address - Street 1:101 WOODBRIDGE DR BLDG B
Practice Address - Street 2:STE 101 AND 102
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-0109
Practice Address - Country:US
Practice Address - Phone:830-581-8027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty