Healthcare Provider Details

I. General information

NPI: 1497089338
Provider Name (Legal Business Name): LUKAS MATTHEW RHOADS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE SUITE 180
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 3199
GRAND JUNCTION CO
81502-3199
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3633
  • Fax: 970-668-4406
Mailing address:
  • Phone: 970-241-0202
  • Fax: 970-245-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2009024423
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0004344
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: