=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427153568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEIRDRE M RHOAD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 08/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11671 JOLLYVILLE RD STE 103
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-476-9149
-----------------------------------------------------
Fax | 512-476-8654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11671 JOLLYVILLE RD STE 103
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-476-9149
-----------------------------------------------------
Fax | 512-476-8654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | H4642
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------