Provider Demographics
NPI:1063470862
Name:RHODES, RAY N JR (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:N
Last Name:RHODES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:6401 HARRIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6101
Practice Address - Country:US
Practice Address - Phone:817-346-2525
Practice Address - Fax:817-294-1692
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4404730OtherAETNA
TX10029179OtherAMERIGROUP
TX130900705OtherMEDICAID EPSDT
TX8FE215OtherBCBS-TX
TX135099309Medicaid
TX83210XOtherBCBS
TX135099302Medicaid
TX4404730OtherAETNA
TX417395YMJCMedicare PIN