Provider Demographics
NPI:1336153949
Name:RHODES, EDGAR LEEON III (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:LEEON
Last Name:RHODES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 720486
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4357
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:3 SHIRCLIFF WAY STE 520
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4777
Practice Address - Country:US
Practice Address - Phone:904-308-2273
Practice Address - Fax:904-308-5267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY39823207P00000X
FL39823207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYE59389Medicare UPIN