MEDICARE: MR. DIRK TIMOTHY RAINWATER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	025000	LA
2	208D00000X	General Practice Physician	MD.025000	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043286230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIRK TIMOTHY RAINWATER MD

Provider Business Mailing Address
First Line	:	103 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-1569
Fax Number	:	318-259-8523

Provider Business Practice Location Address
First Line	:	103 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-1569
Fax Number	:	318-259-8523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	09/04/2019

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