Provider Demographics
NPI:1619922275
Name:REGO, RAYBURN FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:RAYBURN
Middle Name:FRANCIS
Last Name:REGO
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 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 783
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:251-470-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26082207RG0100X
ARE-5416207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524344OtherBLUE CROSS
AL009974775Medicaid
AL009967985Medicaid
AL009967995Medicaid
AR5N927OtherBCBS
MS03905876Medicaid
AR165387001Medicaid
FL267022400Medicaid
AL51527493OtherBLUE CROSS
ARP00407119OtherRAILROAD MEDICARE1
AR07070023500OtherQUALCHOICE
AL51524345OtherBLUE CROSS
AL051524344Medicare ID - Type Unspecified
MS03905876Medicaid
AR5N927Medicare PIN
ALP00269086Medicare ID - Type UnspecifiedRAILROAD PGBA