Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 50043 | CO |
N | 207X00000X | Orthopaedic Surgeon | ML20008591 | WA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD158150 | OR |
NPI | 1144335951 |
---|---|
Provider Name | Derek D. Rains |
First Address | Mcminnville, OR 97128-6255 |
Second Address | Mcminnville, OR 97128-6255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 25/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64826724 | (05) | CO |