Provider Demographics
NPI:1316046162
Name:RHOADS, DANIEL R (PAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:RHOADS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 330W
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-624-1184
Mailing Address - Fax:509-625-1449
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 330W
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-624-1184
Practice Address - Fax:509-625-1449
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA070010731OtherRAILROAD MEDICARE
WAS42041Medicare UPIN
WAG1316046162Medicare PIN