MEDICARE: S. TRACY RHODES, M.D. P.A.

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	207R00000X	Internal Medicine Physician	ME60716	FL

General Provider Information

NPI Number	:	1588835565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. TRACY RHODES, M.D. P.A.

Provider Business Mailing Address
First Line	:	5474 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1036
Country	:	US
Telephone Number	:	407-679-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5526 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1036
Country	:	US
Telephone Number	:	407-679-3400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRACY RHODES
Credential	:	M.D.
Telephone Number	:	407-679-3400

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	05/03/2010

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