Provider Demographics
NPI:1790780658
Name:RAINWATER, HAROLD GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:GREG
Last Name:RAINWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:RAINWATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6113 N FRESNO ST # 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5207
Mailing Address - Country:US
Mailing Address - Phone:559-438-2777
Mailing Address - Fax:559-438-4117
Practice Address - Street 1:6113 N FRESNO ST # 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5207
Practice Address - Country:US
Practice Address - Phone:559-438-2777
Practice Address - Fax:559-438-4117
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG427180208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G427180Medicaid
CA00G427180Medicaid
CAA49086Medicare UPIN