Provider Demographics
NPI:1578781068
Name:LADONNA P RUTLEDGE MD, PA
Entity Type:Organization
Organization Name:LADONNA P RUTLEDGE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-323-9900
Mailing Address - Street 1:1701 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3121
Mailing Address - Country:US
Mailing Address - Phone:979-323-0997
Mailing Address - Fax:
Practice Address - Street 1:1701 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3121
Practice Address - Country:US
Practice Address - Phone:979-323-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4692207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN