Basic Information
| Provider Information | |||||||||
| NPI: | 1063416469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELKIN | ||||||||
| FirstName: | ROD | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 NE 66TH AVE. | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602544914 | ||||||||
| FaxNumber: | 3604494961 | ||||||||
| Practice Location | |||||||||
| Address1: | 4816A NE THURSTON WAY | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602544914 | ||||||||
| FaxNumber: | 3604494961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD00025808 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD12469 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 8143729 | 05 | WA | MEDICAID |