Provider Demographics
NPI:1972568400
Name:RHOADES, PATRICK NEAL (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:NEAL
Last Name:RHOADES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MABLE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1120
Mailing Address - Country:US
Mailing Address - Phone:209-571-1992
Mailing Address - Fax:209-571-1994
Practice Address - Street 1:1300 MABLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1120
Practice Address - Country:US
Practice Address - Phone:209-571-1992
Practice Address - Fax:209-571-1994
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA5194902081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A519490Medicaid
CAZZZ23421ZMedicare ID - Type Unspecified
CA00A519490Medicaid