Healthcare Provider Details

I. General information

NPI: 1639308588
Provider Name (Legal Business Name): SUZANNE MICHELLE RHODES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE RHODES MD

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N BEAVER ST
FLAGSTAFF AZ
86001-3126
US

IV. Provider business mailing address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-6235
  • Fax:
Mailing address:
  • Phone: 928-213-6235
  • Fax: 928-213-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45980
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number45980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: