1346275302 NPI number — JOHN M RAYBURN MD

Table of content: JOHN M RAYBURN MD (NPI 1346275302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346275302 NPI number — JOHN M RAYBURN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYBURN
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346275302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 960454
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73196-0454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-684-1598
Provider Business Mailing Address Fax Number:
405-844-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 NORRIS ST
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
EUREKA SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72632-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-253-7400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  C7959 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0005X , with the licence number: C7959 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: C-7959 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00765216 . This is a "RRMCARE THRU WCMC" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 118261001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01256888 . This is a "RRMCARE THRU GEP" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".