Provider Demographics
NPI:1477586592
Name:RATHBUN, KATHARINE C (MD)
Entity type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:C
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 1:3808 TWELVE OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-2000
Mailing Address - Country:US
Mailing Address - Phone:225-819-9242
Mailing Address - Fax:225-819-9558
Practice Address - Street 1:3808 TWELVE OAKS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-2000
Practice Address - Country:US
Practice Address - Phone:225-819-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14434R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1134261Medicaid
LA1134261Medicaid
4E597Medicare ID - Type Unspecified