Provider Demographics
NPI:1205076270
Name:TIMOTHY RATHBUN, D.O., P.C.
Entity type:Organization
Organization Name:TIMOTHY RATHBUN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:RATHBUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-644-5160
Mailing Address - Street 1:4221 S WESTERN AVE
Mailing Address - Street 2:S-5000
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-644-5160
Mailing Address - Fax:405-644-5162
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:S-5000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5160
Practice Address - Fax:405-644-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty