Provider Demographics
NPI:1376507434
Name:TENORIO, RANA O (MD)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:O
Last Name:TENORIO
Suffix:
Gender:F
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 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1235 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-820-2364
Practice Address - Fax:417-820-7136
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6J21208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202733416Medicaid
MOP00440179OtherRR MEDICARE PROVIDER #
P00302537OtherRR MEDICARE
MO168075001Medicaid
MO904423268Medicare PIN
MO202733416Medicaid
P00302537OtherRR MEDICARE