Healthcare Provider Details

I. General information

NPI: 1467609016
Provider Name (Legal Business Name): GERARD F. RAINER DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 MILESTONE WAY STE A
GREENVILLE SC
29615-5007
US

IV. Provider business mailing address

148 MILESTONE WAY STE A
GREENVILLE SC
29615-5007
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-0048
  • Fax: 864-288-0784
Mailing address:
  • Phone: 864-288-0048
  • Fax: 864-288-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number533
License Number StateSC

VIII. Authorized Official

Name: DR. GERARD F RAINER
Title or Position: OWNER
Credential: DPM
Phone: 864-288-0048