Provider Demographics
NPI:1104093392
Name:RHOADS, JAMIE LYNN WOODCOCK (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN WOODCOCK
Last Name:RHOADS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A330 SOM 30 N 1900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-6465
Mailing Address - Fax:801-581-6484
Practice Address - Street 1:6095 S FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7397
Practice Address - Country:US
Practice Address - Phone:801-581-2955
Practice Address - Fax:801-581-6484
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8134520-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology