Provider Demographics
NPI:1982629069
Name:RHOADS, JON MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MARC
Last Name:RHOADS
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-6516
Practice Address - Fax:713-512-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.14871R2080P0206X
TXM54682080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143138Medicaid
TX181237202OtherCSHCN
TX181237201Medicaid
TX8U4868OtherBCBS
LA1143138Medicaid
C89441Medicare UPIN
TX181237201Medicaid