MEDICARE: DR. KERRY T. RHODES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336105394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY T. RHODES DPM

Provider Business Mailing Address
First Line	:	6080 S. HULEN ST.
Second Line	:	PMB 215 SUITE 360
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-239-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 SOUTH HULEN STREET
Second Line	:	SUITE 360 PMB 215
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4810
Country	:	US
Telephone Number	:	682-205-1427
Fax Number	:	817-887-5837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/21/2022

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