MEDICARE: JOHN MATTOX RAINES D.O.

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	417640	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51519309	OTHER	AL	BLUE CROSS AND BLUE SHIEL
2	01D0888565	OTHER	AL	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679587737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MATTOX RAINES D.O.

Provider Business Mailing Address
First Line	:	190 INDEPENDENT DR STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3286
Country	:	US
Telephone Number	:	256-442-1834
Fax Number	:	877-991-4819

Provider Business Practice Location Address
First Line	:	190 INDEPENDENT DR STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3286
Country	:	US
Telephone Number	:	256-442-1834
Fax Number	:	877-991-4819

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/13/2023

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