Healthcare Provider Details

I. General information

NPI: 1336105394
Provider Name (Legal Business Name): KERRY T. RHODES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/21/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 SOUTH HULEN STREET SUITE 360 PMB 215
FORT WORTH TX
76132-4810
US

IV. Provider business mailing address

6080 S. HULEN ST. PMB 215 SUITE 360
FORT WORTH TX
76132
US

V. Phone/Fax

Practice location:
  • Phone: 682-205-1427
  • Fax: 817-887-5837
Mailing address:
  • Phone: 817-239-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: