Provider Demographics
NPI:1801202718
Name:RHODES, ERIC STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEPHEN
Last Name:RHODES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-6974
Mailing Address - Fax:
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 325
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-533-5903
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9108035363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015269100Medicaid