Provider Demographics
NPI:1629028741
Name:RHODES, JERRY ROBERT (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ROBERT
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 N 260 WEST CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2790
Mailing Address - Country:US
Mailing Address - Phone:435-668-0906
Mailing Address - Fax:
Practice Address - Street 1:594 N 260 WEST CIR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2790
Practice Address - Country:US
Practice Address - Phone:435-668-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT156198-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0004328723OtherAETNA
UT107007770102OtherIHC
UT201302841 B58557OtherBCBS FED PETERSON
UT201302847OtherCURRENT TAX ID
UT218306OtherALTIUS
UT251984OtherOTHER ID
UT36550OtherDMBA
UT101009187101OtherIHC CAPS
UT201302841OtherTAX ID
UT0007137728OtherAETNA
UT201302841793981OtherOTHER ID
AZH605416OtherAEI
UT19344612000001OtherVALUECARE
UT902568OtherDMBA PETERSON
UT201302841 B69047OtherBCBS FED
OR85120066610450OtherREGENCE LIFE & HEALTH
UT251984OtherOTHER ID
UT201302841OtherTAX ID
UT36550OtherDMBA