MEDICARE: JOEL R. RAINWATER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	25390	AZ
2	2085R0204X	Vascular & Interventional Radiology Physician	25390	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518956499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL R. RAINWATER M.D.

Provider Business Mailing Address
First Line	:	838 W ELLIOT RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5162
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 W ELLIOT RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5162
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/04/2021

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