Provider Demographics
NPI:1255392692
Name:LASTRAP, RHODESIA N (DO)
Entity type:Individual
Prefix:
First Name:RHODESIA
Middle Name:N
Last Name:LASTRAP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 BOOTH CALLOWAY RD
Mailing Address - Street 2:STE 506
Mailing Address - City:NRH
Mailing Address - State:TX
Mailing Address - Zip Code:76180
Mailing Address - Country:US
Mailing Address - Phone:817-590-2229
Mailing Address - Fax:817-590-8181
Practice Address - Street 1:4375 BOOTH CALLOWAY RD
Practice Address - Street 2:STE 506
Practice Address - City:NRH
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-590-2229
Practice Address - Fax:817-590-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115126801Medicaid
TX00J880QMedicare ID - Type Unspecified
TX115126801Medicaid