Provider Demographics
NPI:1225117526
Name:JOBE, RAYNA T (MD)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:T
Last Name:JOBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAYNA
Other - Middle Name:CARIN
Other - Last Name:TRUDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2750 GOLF RD
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2062
Mailing Address - Country:US
Mailing Address - Phone:262-928-4900
Mailing Address - Fax:262-928-4960
Practice Address - Street 1:2750 GOLF RD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2062
Practice Address - Country:US
Practice Address - Phone:262-928-4900
Practice Address - Fax:262-928-4960
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33184207Q00000X
WI61644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68375Medicare PIN