Provider Demographics
NPI:1073515698
Name:RHODES, EDWARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1109
Mailing Address - Country:US
Mailing Address - Phone:303-321-4212
Mailing Address - Fax:303-388-2459
Practice Address - Street 1:2005 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1109
Practice Address - Country:US
Practice Address - Phone:303-321-4212
Practice Address - Fax:303-388-2459
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01161702Medicaid
COM4318Medicare ID - Type Unspecified
CO01161702Medicaid