Provider Demographics
NPI:1073724514
Name:RAINEY, JOHN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:RAINEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3521 HIGHWAY 190
Mailing Address - Street 2:SUITE P
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-457-8040
Mailing Address - Fax:337-457-8043
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:SUITE P
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-457-8040
Practice Address - Fax:337-457-8043
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.203801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099619Medicaid