Provider Demographics
NPI:1558345686
Name:RATHBUN, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:RATHBUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:997 HIGHWAY 17 SOUTH
Mailing Address - Street 2:# C
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6084
Mailing Address - Country:US
Mailing Address - Phone:843-839-4505
Mailing Address - Fax:843-839-2851
Practice Address - Street 1:997 HIGHWAY 17 SOUTH
Practice Address - Street 2:# C
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6084
Practice Address - Country:US
Practice Address - Phone:843-839-4505
Practice Address - Fax:843-839-2851
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0772Medicaid
SC5200Medicare ID - Type UnspecifiedBILLING ADDRESS
SCE861915200Medicare PIN
SCGP0772Medicaid