Healthcare Provider Details

I. General information

NPI: 1164589552
Provider Name (Legal Business Name): PETER JOHN RHODEN AP DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 N ANDREWS AVE
WILTON MANORS FL
33311-2511
US

IV. Provider business mailing address

6170 SW 195TH AVE
FORT LAUDERDALE FL
33332-3391
US

V. Phone/Fax

Practice location:
  • Phone: 954-568-5252
  • Fax: 954-568-6833
Mailing address:
  • Phone: 954-434-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberAP0001048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: