Healthcare Provider Details

I. General information

NPI: 1245674118
Provider Name (Legal Business Name): RYAN RHODES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 201
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7440
  • Fax: 985-230-7441
Mailing address:
  • Phone: 985-230-7440
  • Fax: 985-230-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD.207246
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207246
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: