MEDICARE: RANDALL RAINE D.O.

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	207R00000X	Internal Medicine Physician	3486	OK
2	207R00000X	Internal Medicine Physician	OS19288	FL

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	:	1588636013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL RAINE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 947407
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7407
Country	:	US
Telephone Number	:	941-917-2600
Fax Number	:	941-917-7884

Provider Business Practice Location Address
First Line	:	8431 POINTE LOOP DR FL 2
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2232
Country	:	US
Telephone Number	:	941-261-1900
Fax Number	:	941-261-0887

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/17/2025

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Directions to “ RANDALL RAINE D.O.” Practice Location

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