Provider Demographics
NPI:1346275302
Name:RAYBURN, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:RAYBURN
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:PO BOX 960454
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0454
Mailing Address - Country:US
Mailing Address - Phone:800-684-1598
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:24 NORRIS ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3541
Practice Address - Country:US
Practice Address - Phone:479-253-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7959207PE0004X, 207PE0005X
ARC-7959207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00765216OtherRRMCARE THRU WCMC
AR118261001Medicaid
ARP01256888OtherRRMCARE THRU GEP
AR54346B637Medicare PIN
ARP00765216OtherRRMCARE THRU WCMC
AR118261001Medicaid
ARP01256888OtherRRMCARE THRU GEP