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General NPI Number Information
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NPI Number | 1285997494
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Entity Type | Individual
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Provider Name | JORDAN D RAYNOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1050 REID PKWY., STE. 210
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City | RICHMOND
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State | IN
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Zip | 47374-1160
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Country | US
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Telephone | 765-939-7711
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Fax | 765-939-1841
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Provider Business Mailing Address
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Address Line | 1100 REID PKWY MEDICAL STAFF SERVICES
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City | RICHMOND
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State | IN
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Zip | 47374-1157
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Country | US
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Telephone | 765-939-7711
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Fax | 765-939-1841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01076777A
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License Number State | IN
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