MEDICARE: DR. ALTON CLARK RAYNOR 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	208200000X	Plastic Surgery Physician	ME31308	FL

General Provider Information

NPI Number	:	1407853989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALTON CLARK RAYNOR M.D.

Provider Business Mailing Address
First Line	:	845 SE OSCEOLA ST
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2431
Country	:	US
Telephone Number	:	772-286-2202
Fax Number	:	772-286-2389

Provider Business Practice Location Address
First Line	:	845 SE OSCEOLA ST
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2431
Country	:	US
Telephone Number	:	772-286-2202
Fax Number	:	772-286-2389

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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