Provider Demographics
NPI:1043286230
Name:RAINWATER, DIRK TIMOTHY (MD)
Entity Type:Individual
Prefix:MR
First Name:DIRK
Middle Name:TIMOTHY
Last Name:RAINWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2053
Mailing Address - Country:US
Mailing Address - Phone:318-259-1569
Mailing Address - Fax:318-259-8523
Practice Address - Street 1:103 WATTS ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2053
Practice Address - Country:US
Practice Address - Phone:318-259-1569
Practice Address - Fax:318-259-8523
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025000207P00000X
LAMD.025000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1423459Medicaid
LA1423459Medicaid
LA4A525DX99Medicare PIN