Provider Demographics
NPI:1083837330
Name:RHOADES, DOROTHY A (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:RHOADES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 NE 13TH STREET
Mailing Address - Street 2:ORI 274
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-1515
Mailing Address - Fax:405-271-1476
Practice Address - Street 1:655 RESEARCH PKWY STE 449
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-6276
Practice Address - Country:US
Practice Address - Phone:405-271-5896
Practice Address - Fax:405-271-1476
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8276354Medicaid
WAF41247Medicare UPIN
WA8276354Medicaid