MEDICARE: LADONNA P RUTLEDGE MD, PA

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	207VX0000X	Obstetrics Physician	M4692	TX

General Provider Information

NPI Number	:	1578781068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADONNA P RUTLEDGE MD, PA

Provider Business Mailing Address
First Line	:	1701 GOLDEN AVE
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-3121
Country	:	US
Telephone Number	:	979-323-0997
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	:	979-323-0997
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LADONNA P RUTLEDGE
Credential	:	MD
Telephone Number	:	979-323-9900

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/11/2011

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