MEDICARE: LADONNA PATRICE RUTLEDGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	M4692	TX

General Provider Information

NPI Number	:	1194813550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADONNA PATRICE RUTLEDGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2870
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77404-2870
Country	:	US
Telephone Number	:	979-323-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 GOLDEN AVE
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-3121
Country	:	US
Telephone Number	:	979-323-9900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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