Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 013420 | GA |
N | 207KA0200X | Allergist | 13420 | GA |
N | 207Q00000X | Family Doctor | 013420 | GA |
Y | 207Q00000X | Family Doctor | 13420 | GA |
NPI | 1639148224 |
---|---|
Provider Name | Robert B Rhoades |
First Address | Augusta, GA 30909-1899 |
Second Address | Augusta, GA 30909-1899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 04/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000013142A | (05) | GA |
202I014512 | (02) | GA |
406012153 | (02) | GA |
D40963 | (02) | GA |