Healthcare Provider Details

I. General information

NPI: 1316258171
Provider Name (Legal Business Name): JOHN CHARLES RHODES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 BANBURRY CROSS DR STE 150
LAS VEGAS NV
89144-6647
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-8500
  • Fax: 702-560-2928
Mailing address:
  • Phone: 702-560-2886
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6286
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: