Provider Demographics
NPI:1639364078
Name:RATHBUN-DUNCAN, KATHLEEN S (D O)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:S
Last Name:RATHBUN-DUNCAN
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 LAKE WORTH RD
Mailing Address - Street 2:STE 109
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3480
Mailing Address - Country:US
Mailing Address - Phone:561-790-4445
Mailing Address - Fax:561-790-4237
Practice Address - Street 1:4889 LAKE WORTH RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3499
Practice Address - Country:US
Practice Address - Phone:561-649-7532
Practice Address - Fax:561-649-7535
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000738901Medicaid
FL000738900Medicaid
FL000738901Medicaid
FL000738900Medicaid