MEDICARE: DEIRDRE M RHOAD 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	208200000X	Plastic Surgery Physician	H4642	TX

General Provider Information

NPI Number	:	1427153568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE M RHOAD M.D.

Provider Business Mailing Address
First Line	:	11671 JOLLYVILLE RD STE 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4141
Country	:	US
Telephone Number	:	512-476-9149
Fax Number	:	512-476-8654

Provider Business Practice Location Address
First Line	:	11671 JOLLYVILLE RD STE 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4141
Country	:	US
Telephone Number	:	512-476-9149
Fax Number	:	512-476-8654

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/02/2021

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