Provider Demographics
NPI:1073716387
Name:RHODEN, RICHARD EARL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:RHODEN
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 1:4500 I-55 NORTH
Mailing Address - Street 2:SUITE 248
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5966
Mailing Address - Country:US
Mailing Address - Phone:601-982-8330
Mailing Address - Fax:601-982-8314
Practice Address - Street 1:4500 I-55 NORTH
Practice Address - Street 2:SUITE 248
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5966
Practice Address - Country:US
Practice Address - Phone:601-982-8330
Practice Address - Fax:601-982-8314
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS064602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0013854Medicaid
MS0013854Medicaid