Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 038339 | GA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 038339 | GA |
NPI | 1235173964 |
---|---|
Provider Name | Dr. Robert Brian Raybon |
First Address | Columbus, GA 31902-1914 |
Second Address | Watkinsville, GA 30677-7311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000795682B | (05) | GA |
000795682C | (05) | GA |
G52288 | (02) | GA |