Provider Demographics
NPI:1679851901
Name:DEIRDRE M RHOAD M D P A
Entity type:Organization
Organization Name:DEIRDRE M RHOAD M D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOAD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:512-476-9149
Mailing Address - Street 1:11111 RESEARCH BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5264
Mailing Address - Country:US
Mailing Address - Phone:512-476-9149
Mailing Address - Fax:512-476-8654
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:512-476-9149
Practice Address - Fax:512-476-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF63637Medicare UPIN