Provider Demographics
NPI:1891898946
Name:RAYNOR, LAURENCE MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:MATTHEW
Last Name:RAYNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34310
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134
Mailing Address - Country:US
Mailing Address - Phone:402-778-9738
Mailing Address - Fax:402-334-2849
Practice Address - Street 1:6901 N 72 STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-778-9738
Practice Address - Fax:402-334-2849
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22163207L00000X
IA37163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0552190Medicaid
NE47-0550438-13Medicaid
NE275328Medicare ID - Type Unspecified
H57493Medicare UPIN