Provider Demographics
NPI:1760496467
Name:RAYFORD, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RAYFORD
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 1:1040 RIVER OAKS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9531
Mailing Address - Country:US
Mailing Address - Phone:601-933-5417
Mailing Address - Fax:601-936-1336
Practice Address - Street 1:1040 RIVER OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9531
Practice Address - Country:US
Practice Address - Phone:601-933-5417
Practice Address - Fax:601-936-1336
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14081207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119495Medicaid
MS0119495Medicaid
MSF83661Medicare UPIN