Organization
RDM SURGICAL ASSISTANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA LOU AUTRY PA-C (OWNER)
(812) 267-6695
Entity
Organization
Contact information
Practice address
10081 FREDERICKSBURG RD NW, DEPAUW, IN 47115-8629
(812) 267-6695
Mailing address
10081 FREDERICKSBURG RD NW, DEPAUW, IN 47115-8629
(812) 267-6695
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
05/07/2020
Last updated
06/04/2020
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