=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205958378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C ALLEN RHODES MD CHARTERED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4416 S EASTERN AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-7825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-836-3342
-----------------------------------------------------
Fax | 702-836-3344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4416 S EASTERN AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-7825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-836-3342
-----------------------------------------------------
Fax | 702-836-3344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PROF. CHARLES ALLEN RHODES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-836-3342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------