Provider Demographics
NPI:1497438873
Name:RHODES, JORDAN WAYNE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:WAYNE
Last Name:RHODES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E 1400 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3853
Mailing Address - Country:US
Mailing Address - Phone:801-489-8960
Mailing Address - Fax:
Practice Address - Street 1:230 E 400 S STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1972
Practice Address - Country:US
Practice Address - Phone:385-325-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program