Provider Demographics
NPI:1356940878
Name:RAINWATER, GILBERT LARNCE
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:LARNCE
Last Name:RAINWATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6987 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-9751
Mailing Address - Country:US
Mailing Address - Phone:937-248-1630
Mailing Address - Fax:
Practice Address - Street 1:6987 JORDAN RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-9751
Practice Address - Country:US
Practice Address - Phone:937-248-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver