Healthcare Provider Details

I. General information

NPI: 1104876507
Provider Name (Legal Business Name): STEPHEN C RAYNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL - PEDIATRIC SURGERY 8200 DODGE STREET
OMAHA NE
68114-4113
US

IV. Provider business mailing address

CHILDREN'S HOSPITAL 8200 DODGE STREET
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7400
  • Fax: 402-955-7405
Mailing address:
  • Phone: 405-955-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number16699
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: