Provider Demographics
NPI:1871554550
Name:SAWYER, RODERICK J (MD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:J
Last Name:SAWYER
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 1:285 W 12TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1653
Mailing Address - Country:US
Mailing Address - Phone:765-475-8570
Mailing Address - Fax:765-640-8125
Practice Address - Street 1:285 W 12TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1653
Practice Address - Country:US
Practice Address - Phone:765-475-8570
Practice Address - Fax:765-640-8125
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045032A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200098870Medicaid
INF72913Medicare UPIN
IN200098870Medicaid
IN306210PPMedicare ID - Type Unspecified