MEDICARE: TIFFANY POWELL RAYNOR 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	207YP0228X	Pediatric Otolaryngology Physician	OH57010911	OH

General Provider Information

NPI Number	:	1396812749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY POWELL RAYNOR MD

Provider Business Mailing Address
First Line	:	6550 FANNIN STREET
Second Line	:	SUITE 2001
City	:	HOUSTON
State	:	TX
Zip	:	77033-2725
Country	:	US
Telephone Number	:	713-796-2001
Fax Number	:	713-796-2349

Provider Business Practice Location Address
First Line	:	6550 FANNIN STREET
Second Line	:	SUITE 2001
City	:	HOUSTON
State	:	TX
Zip	:	77033-2725
Country	:	US
Telephone Number	:	713-796-2001
Fax Number	:	713-796-2349

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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