MEDICARE: ABBEY P. RAYNOR PA-C

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	363AM0700X	Medical Physician Assistant	4497	AZ
2	363A00000X	Physician Assistant	4497	AZ

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	:	1073846853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY P. RAYNOR PA-C

Provider Business Mailing Address
First Line	:	PO BOX 6730
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6730
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-821-3610

Provider Business Practice Location Address
First Line	:	37100 N GANTZEL RD STE 106
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7350
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-821-3610

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

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	05/30/2024

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Directions to “ ABBEY P. RAYNOR PA-C” Practice Location

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