=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043532187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHODESIA N LASTRAP DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2010
-----------------------------------------------------
Last Update Date | 02/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4375 BOOTH CALLOWAY RD SUITE 506
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76180-8359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-590-2229
-----------------------------------------------------
Fax | 817-590-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4375 BOOTH CALLOWAY RD SUITE 506
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76180-8359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-590-2229
-----------------------------------------------------
Fax | 817-590-8181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RHODESIA N LASTRAP
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 817-590-2229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------