Provider Demographics
NPI:1104851039
Name:RHOADES, JODY M (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:M
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 1:1909 214TH ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4412
Mailing Address - Country:US
Mailing Address - Phone:425-412-7200
Mailing Address - Fax:425-412-7341
Practice Address - Street 1:1909 214TH ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-412-7200
Practice Address - Fax:425-412-7281
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60101060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8884998OtherMEDICARE
WA8556789Medicaid
WAG8884999OtherMEDICARE
WAG8884999OtherMEDICARE