Individual
DR. MARCUS ERVIN RAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 460-1347
Mailing address
6635 COUNTY ROAD 427, AUBURN, IN 46706-9619
(912) 288-5681
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01062393A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200825050
—
IN
01
—
P00388839
RAIL ROAD
IN
Enumeration date
06/05/2006
Last updated
11/07/2024
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