Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 025000 | LA |
Y | 208D00000X | General Practice Physician | MD.025000 | LA |
NPI | 1043286230 |
---|---|
Provider Name | Mr. Dirk Timothy Rainwater |
First Address | Jonesboro, LA 71251-2053 |
Second Address | Jonesboro, LA 71251-2053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1423459 | (05) | LA |
H44720 | (02) |