Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301075052 | MI |
NPI | 1003802570 |
---|---|
Provider Name | Jody C Rhames |
First Address | Adrian, MI 49221-1478 |
Second Address | Adrian, MI 49221-1478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000378442 | ANTHEM (01) | |
0804601681 | BCBS MI (01) | |
125902 | CARECHOICES/PREFERRED CHO (01) | |
4783565 | (05) | MI |
7121036 | AETNA (01) | |
H07115 | (02) | MI |
P00254434 | RRMC (01) |