MEDICARE: DANA P RABIDEAU MD

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	207RN0300X	Nephrology Physician	N6097	AR
2	207RN0300X	Nephrology Physician	15018	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710974548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA P RABIDEAU MD

Provider Business Mailing Address
First Line	:	PO BOX 402319
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2319
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1500 DODSON AVE
Second Line	:	STE 280
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5182
Country	:	US
Telephone Number	:	479-709-7480
Fax Number	:	479-709-7479

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/23/2010

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Directions to “ DANA P RABIDEAU MD” Practice Location

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