Provider Demographics
NPI:1871609057
Name:RHODES, GREGORY ALTON (CRNA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALTON
Last Name:RHODES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-202-2093
Mailing Address - Fax:501-202-6316
Practice Address - Street 1:1703 N BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:501-202-2093
Practice Address - Fax:501-202-6316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858108367500000X
ARC003138367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07286254Medicaid
MS43001640Medicare ID - Type Unspecified