MEDICARE: DR. JOHN CHARLES RHODES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6286	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316258171	OTHER	NV	NPI
2	207Q00000X	OTHER	NV	TAXONOMY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6286	OTHER	NV	NV STATE LICENSE

General Provider Information

NPI Number	:	1316258171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES RHODES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	702-560-2886
Fax Number	:	702-560-2928

Provider Business Practice Location Address
First Line	:	10105 BANBURRY CROSS DR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6647
Country	:	US
Telephone Number	:	702-243-8500
Fax Number	:	702-560-2928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2010
Last Update Date	:	04/13/2015

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