Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2008006634 | MO |
NPI | 1134350507 |
---|---|
Provider Name | Dr. Jonathan James Rhoades |
First Address | Cape Girardeau, MO 63703 |
Second Address | Cape Girardeau, MO 63703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 10/11/2009 |