Individual
JOHN MATTOX RAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
190 INDEPENDENT DR STE A, RAINBOW CITY, AL 35906-3286
(256) 442-1834
(877) 991-4819
Mailing address
190 INDEPENDENT DR STE A, RAINBOW CITY, AL 35906-3286
(256) 442-1834
(877) 991-4819
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
417640
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009938835
—
AL
01
—
01D0888565
CLIA
AL
01
—
51519309
BLUE CROSS AND BLUE SHIEL
AL
Enumeration date
07/27/2006
Last updated
03/13/2023
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