# RDM SURGICAL ASSISTANT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265054712
- **Authorized official:** REBECCA LOU AUTRY PA-C (OWNER)
- **Authorized official phone:** (812) 267-6695

## Contact information

- **Practice address:** 10081 FREDERICKSBURG RD NW, DEPAUW, IN 47115-8629
- **Practice address phone:** (812) 267-6695
- **Mailing address:** 10081 FREDERICKSBURG RD NW, DEPAUW, IN 47115-8629
- **Mailing address phone:** (812) 267-6695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2020
- **Last updated:** 06/04/2020