Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD.41536 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 21555 | MS |
NPI | 1063624948 |
---|---|
Provider Name | Mr. Richard D. Rainey |
First Address | Tupelo, MS 38801 |
Second Address | Tupelo, MS 38801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 05/04/2021 |