Provider Demographics
NPI:1265597629
Name:RAYNOR, DAVID BRYAN (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRYAN
Last Name:RAYNOR
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 1:490 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-5746
Mailing Address - Country:US
Mailing Address - Phone:352-726-3668
Mailing Address - Fax:352-726-1003
Practice Address - Street 1:490 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-5746
Practice Address - Country:US
Practice Address - Phone:352-726-3668
Practice Address - Fax:352-726-1003
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2467213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65400OtherBCBS
FL65400YMedicare PIN
FL65400OtherBCBS
FL65400BMedicare ID - Type Unspecified
FL1258930001Medicare NSC