Provider Demographics
NPI:1447323258
Name:RHODES, JAY G (PA)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:G
Last Name:RHODES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1608
Mailing Address - Country:US
Mailing Address - Phone:954-648-4677
Mailing Address - Fax:
Practice Address - Street 1:1312 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1608
Practice Address - Country:US
Practice Address - Phone:954-648-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001343213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054819700Medicaid
FL650955123OtherEMPLOYER TAX ID #
FL87697Medicare ID - Type UnspecifiedMEDICAIRE ID #
FL054819700Medicaid
FL087697Medicare Oscar/Certification
FL5049840001Medicare NSC