Healthcare Provider Details

I. General information

NPI: 1194008979
Provider Name (Legal Business Name): THOMAS ALLEN RAYNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E CENTER ST
PROVO UT
84606-3554
US

IV. Provider business mailing address

1300 E CENTER ST
PROVO UT
84606-3554
US

V. Phone/Fax

Practice location:
  • Phone: 801-344-4400
  • Fax: 801-344-4225
Mailing address:
  • Phone: 801-344-4400
  • Fax: 801-344-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME157262
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2023044568
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL3127
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2885471-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: