Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2009016034 | MO |
Y | 2081P2900X | Pain Medicine | MD-42655 | IA |
NPI | 1144458852 |
---|---|
Provider Name | John Wesley Rayburn |
First Address | Des Moines, IA 50314-3045 |
Second Address | Des Moines, IA 50314-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 15/02/2016 |