Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 14307 | WV |
NPI | 1093781809 |
---|---|
Provider Name | Dr. Larry Rhodes |
First Address | Morgantown, WV 26507-0897 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0112983000 | (05) | WV |
E58177 | (02) |