Provider Demographics
NPI:1235190729
Name:RHODES, DANIEL M (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
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 1:4545 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4706
Mailing Address - Country:US
Mailing Address - Phone:712-274-2400
Mailing Address - Fax:712-274-1484
Practice Address - Street 1:4545 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4706
Practice Address - Country:US
Practice Address - Phone:712-274-2400
Practice Address - Fax:712-274-1484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
75305796351106B003OtherTRICARE
142OtherMIDLANDS CHOICE
NE753057963-13Medicaid
SD7777702Medicaid
IA47473OtherWELLMARK BCBS
SD9216092OtherDAKOTA CARE
IA1219667Medicaid
SD23518OtherSIOUX VALLEY
IAI6937Medicare ID - Type Unspecified
IAA02522Medicare UPIN