1962898833 NPI number — DR. JEFFREY KENT RAINES MD, PHD

Table of content: CHAUNTEL SMITH (NPI 1134704851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962898833 NPI number — DR. JEFFREY KENT RAINES MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAINES
Provider First Name:
JEFFREY
Provider Middle Name:
KENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
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:
1962898833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/29/2022
NPI Reactivation Date:
08/04/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9150 SW 87TH AVE
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-2319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-595-4447
Provider Business Mailing Address Fax Number:
305-248-6320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 SW 87TH AVE
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-595-4447
Provider Business Practice Location Address Fax Number:
305-248-6320
Provider Enumeration Date:
04/08/2015

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: 246XC2903X , with the licence number:  171950 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10D2086850 . This is a "CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57079 . This is a "AMERICAN REGISTRY OF DIAGNOSTIC MEDICAL SONOGRAPHERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 171950 . This is a "FLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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