Provider Demographics
NPI:1659380418
Name:RAUTH, VIRGINIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LYNN
Last Name:RAUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:A
Other - Last Name:RAUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:701 W 5TH ST
Mailing Address - Street 2:TEXAS TECH UNIVERSITY HEALTH SCI CTR/PERMIAN BASIN
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-335-5200
Mailing Address - Fax:432-335-5240
Practice Address - Street 1:701 W 5TH ST
Practice Address - Street 2:TEXAS TECH UNIVERSITY HEALTH SCI CTR/PERMIAN BASIN
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4206
Practice Address - Country:US
Practice Address - Phone:432-335-5200
Practice Address - Fax:432-335-5240
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8837207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128387106Medicaid
TX128387106Medicaid
TXB25805Medicare UPIN