Provider Demographics
NPI:1710139233
Name:ROHDE, BRET G (RPA, RT(R))
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:G
Last Name:ROHDE
Suffix:
Gender:M
Credentials:RPA, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W 600 N
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-2400
Mailing Address - Country:US
Mailing Address - Phone:435-257-4366
Mailing Address - Fax:801-442-0130
Practice Address - Street 1:440 W 600 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2400
Practice Address - Country:US
Practice Address - Phone:435-257-4366
Practice Address - Fax:801-442-0130
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT02 UT 1044243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant