Provider Demographics
NPI:1538154414
Name:RATHBUN, TIMOTHY F (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:F
Last Name:RATHBUN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-604-4486
Mailing Address - Fax:405-602-1898
Practice Address - Street 1:5401 N PORTLAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2126
Practice Address - Country:US
Practice Address - Phone:405-604-4486
Practice Address - Fax:405-602-1898
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK41122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA3411Medicare PIN
OK241404201Medicare PIN
OK243630002Medicare PIN