Healthcare Provider Details

I. General information

NPI: 1548244403
Provider Name (Legal Business Name): CHRIS B RATHBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 A C SKINNER PKWY SUITE 160
JACKSONVILLE FL
32256-6954
US

IV. Provider business mailing address

PO BOX 551308
JACKSONVILLE FL
32255-1308
US

V. Phone/Fax

Practice location:
  • Phone: 904-622-9035
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-493-3333
  • Fax: 904-493-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME43492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: