Provider Demographics
NPI:1679587737
Name:RAINES, JOHN MATTOX (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTOX
Last Name:RAINES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 INDEPENDENT DR STE A
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-3286
Mailing Address - Country:US
Mailing Address - Phone:256-442-1834
Mailing Address - Fax:877-991-4819
Practice Address - Street 1:190 INDEPENDENT DR STE A
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-3286
Practice Address - Country:US
Practice Address - Phone:256-442-1834
Practice Address - Fax:877-991-4819
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL417640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519309OtherBLUE CROSS AND BLUE SHIEL
AL01D0888565OtherCLIA
AL009938835Medicaid
AL009938835Medicaid
AL51519309Medicare ID - Type Unspecified