Provider Demographics
NPI:1730655994
Name:RHODES, DEVIN TIMOTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:TIMOTHY
Last Name:RHODES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:EARL
Other - Last Name:TIMOTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 S 3270 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1119
Mailing Address - Country:US
Mailing Address - Phone:385-261-2614
Mailing Address - Fax:877-497-4661
Practice Address - Street 1:610 S 200 E STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3802
Practice Address - Country:US
Practice Address - Phone:801-539-8617
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11010003-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant