Healthcare Provider Details

I. General information

NPI: 1588835565
Provider Name (Legal Business Name): S. TRACY RHODES, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5526 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

IV. Provider business mailing address

5474 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-3400
  • Fax:
Mailing address:
  • Phone: 407-679-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME60716
License Number StateFL

VIII. Authorized Official

Name: TRACY RHODES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-679-3400