Healthcare Provider Details

I. General information

NPI: 1487886735
Provider Name (Legal Business Name): ANTHONY WARD RAYNOR P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 DEERFIELD RD
BOONE NC
28607-5008
US

IV. Provider business mailing address

151 HAROLD FLEMING CT
SPARTANBURG SC
29303-4225
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax: 828-262-4103
Mailing address:
  • Phone: 864-573-6320
  • Fax: 864-208-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1396
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01563
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: