Provider Demographics
NPI:1316926082
Name:RATHE, DAVID J (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:RATHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:312 9TH ST SW
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2929
Mailing Address - Country:US
Mailing Address - Phone:319-352-4340
Mailing Address - Fax:319-352-0745
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:SUITE 1200
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-352-4340
Practice Address - Fax:319-352-0745
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA02383207R00000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110126474OtherRR MEDICARE
IA1080994Medicaid
IA1316926082Medicaid
IA1316926082Medicaid
IA1080994Medicaid