Healthcare Provider Details

I. General information

NPI: 1780650242
Provider Name (Legal Business Name): SARA TRACY RHODES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5474 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: 407-679-3412
Mailing address:
  • Phone: 407-679-3400
  • Fax: 407-679-3412

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:
Title or Position:
Credential:
Phone: