1619922275 NPI number — RAYBURN FRANCIS REGO MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619922275 NPI number — RAYBURN FRANCIS REGO MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

REGO

Provider First Name:

RAYBURN

Provider Middle Name:

FRANCIS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1619922275

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/29/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4301 W MARKHAM ST # 783

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LITTLE ROCK

Provider Business Mailing Address State Name:

AR

Provider Business Mailing Address Postal Code:

72205-7101

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

4301 W MARKHAM ST # 783

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LITTLE ROCK

Provider Business Practice Location Address State Name:

AR

Provider Business Practice Location Address Postal Code:

72205-7101

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

251-470-5842

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RG0100X , with the licence number:  26082 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0100X , with the licence number: E-5416 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 51524344 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009974775 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009967985 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009967995 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 5N927 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 03905876 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 165387001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 267022400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 51527493 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: P00407119 . This is a "RAILROAD MEDICARE1" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 07070023500 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 51524345 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".