Healthcare Provider Details

I. General information

NPI: 1336153949
Provider Name (Legal Business Name): EDGAR LEEON RHODES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY STE 520
JACKSONVILLE FL
32204-4777
US

IV. Provider business mailing address

PO BOX 720486
NORMAN OK
73070-4357
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-2273
  • Fax: 904-308-5267
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39823
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number39823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: