Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 104960-0501 | UT |
Y | 222Z00000X | Podiatrist | 104960-0501 | UT |
NPI | 1013932763 |
---|---|
Provider Name | Randy D. Rhodes |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Salt Lake City, UT 84102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T77926 | (02) |