Provider Demographics
NPI:1912358789
Name:RATHBUN, JULIANNE (MD)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3932
Mailing Address - Country:US
Mailing Address - Phone:785-827-9635
Mailing Address - Fax:785-827-6697
Practice Address - Street 1:218 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3932
Practice Address - Country:US
Practice Address - Phone:785-827-9635
Practice Address - Fax:785-827-6697
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020873208600000X
KS04-44458208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016020873OtherMISSOURI BOARD OF HEALING ARTS