Provider Demographics
NPI:1790999100
Name:RAINEY, CHRISTY SHAFFER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:SHAFFER
Last Name:RAINEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3988 HAMMONDS FRY
Mailing Address - Street 2:STE C
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8022
Mailing Address - Country:US
Mailing Address - Phone:210-323-5982
Mailing Address - Fax:210-901-9353
Practice Address - Street 1:110 BUSINESS PARK DR
Practice Address - Street 2:STE C
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7426
Practice Address - Country:US
Practice Address - Phone:417-239-0125
Practice Address - Fax:417-239-0127
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035572207N00000X
TXM8331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204056105Medicaid
MO331015620Medicare UPIN