Healthcare Provider Details

I. General information

NPI: 1790780658
Provider Name (Legal Business Name): HAROLD GREG RAINWATER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GREG RAINWATER M.D.

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6113 N FRESNO ST # 101
FRESNO CA
93710-5207
US

IV. Provider business mailing address

6113 N FRESNO ST # 101
FRESNO CA
93710-5207
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-2777
  • Fax: 559-438-4117
Mailing address:
  • Phone: 559-438-2777
  • Fax: 559-438-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG427180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: