Provider Demographics
NPI:1669441895
Name:RAINER, GERARD F (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:F
Last Name:RAINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MILESTONE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5007
Mailing Address - Country:US
Mailing Address - Phone:864-288-0048
Mailing Address - Fax:864-288-0784
Practice Address - Street 1:148 MILESTONE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5007
Practice Address - Country:US
Practice Address - Phone:864-288-0048
Practice Address - Fax:864-288-0784
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC533213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5337Medicaid
SCT81558Medicare UPIN
SCPD5337Medicaid
SC1231440001Medicare NSC