Provider Demographics
NPI:1497746689
Name:RATHE, PERRY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:SCOTT
Last Name:RATHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S. 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2534
Mailing Address - Country:US
Mailing Address - Phone:515-382-5471
Mailing Address - Fax:515-382-5621
Practice Address - Street 1:230 S. 6TH ST.
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2534
Practice Address - Country:US
Practice Address - Phone:515-382-5471
Practice Address - Fax:515-382-5621
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0111351Medicaid
IA0111351Medicaid
IAF48023Medicare UPIN