Basic Information
| Provider Information | |||||||||
| NPI: | 1407804503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHOADS | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 W 67TH CT | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805381177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705990330 | ||||||||
| FaxNumber: | 9702306811 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 W 67TH CT | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805381177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705990330 | ||||||||
| FaxNumber: | 9702306811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | E-3188 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 207R00000X | E-3188 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 146653001 | 05 | AR | MEDICAID |