Provider Demographics
NPI:1083747554
Name:RAYFORD, CLEVELAND EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:CLEVELAND
Middle Name:EUGENE
Last Name:RAYFORD
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 1:4414 N FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1812
Mailing Address - Country:US
Mailing Address - Phone:314-898-1720
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:4414 N FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1812
Practice Address - Country:US
Practice Address - Phone:314-898-1720
Practice Address - Fax:314-898-1688
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-090011Medicaid
IL036-090011Medicaid