Healthcare Provider Details

I. General information

NPI: 1457443202
Provider Name (Legal Business Name): RAYPAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE NW SUITE 100
WINTER HAVEN FL
33881-4679
US

IV. Provider business mailing address

550 POPE AVE NW SUITE 100
WINTER HAVEN FL
33881-4679
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2144
  • Fax: 863-293-3732
Mailing address:
  • Phone: 863-293-2144
  • Fax: 863-293-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0069091
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY A STANWOOD
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-401-8516