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NPI Code Detail

MEDICARE: JOHNATHAN RHOADS

MEDICARE: JOHNATHAN RHOADS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA18701TX

General Provider Information

NPI Number : 1356028302
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNATHAN RHOADS
Provider Business Mailing Address
First Line : 2627 W JEFFERSON BLVD STE 209
Second Line :
City : DALLAS
State : TX
Zip : 75211-2685
Country : US
Telephone Number : 214-941-0032
Fax Number :
Provider Business Practice Location Address
First Line : 2627 W JEFFERSON BLVD STE 209
Second Line :
City : DALLAS
State : TX
Zip : 75211-2685
Country : US
Telephone Number : 214-941-0032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2023
Last Update Date : 04/29/2025

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Directions to “ JOHNATHAN RHOADS ” Practice Location

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