Provider Demographics
NPI:1356617518
Name:RAINWATER, NATHAN ALLEN (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALLEN
Last Name:RAINWATER
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 1:1134 N 500 W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3383
Mailing Address - Country:US
Mailing Address - Phone:801-357-8310
Mailing Address - Fax:
Practice Address - Street 1:1134 N 500 W
Practice Address - Street 2:SUITE 101
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3383
Practice Address - Country:US
Practice Address - Phone:801-357-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRO-1274207R00000X
UT9218046-1204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine