Healthcare Provider Details

I. General information

NPI: 1669469904
Provider Name (Legal Business Name): ROBERT RHODE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E CAMINO DE JAIME
TUCSON AZ
85718-7435
US

IV. Provider business mailing address

3701 E CAMINO DE JAIME
TUCSON AZ
85718-7435
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-7623
  • Fax:
Mailing address:
  • Phone: 520-615-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number880
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1076
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: