Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD.207406 | LA |
NPI | 1023350816 |
---|---|
Provider Name | Dr. John Brent Rhodes JR. |
First Address | Lafayette, LA 70503-2616 |
Second Address | Lafayette, LA 70503-2616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2335219 | (05) | LA |