MEDICARE: TANNIQUE NATASHA RAINFORD M.D.

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	207Q00000X	Family Medicine Physician	L1435	TX

General Provider Information

NPI Number	:	1134176167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNIQUE NATASHA RAINFORD M.D.

Provider Business Mailing Address
First Line	:	2500 FONDREN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2313
Country	:	US
Telephone Number	:	713-781-4600
Fax Number	:	713-917-5780

Provider Business Practice Location Address
First Line	:	2500 FONDREN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2313
Country	:	US
Telephone Number	:	713-781-4600
Fax Number	:	713-917-5780

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	09/21/2010

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