Individual
DR. OTHA RAY RAINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11123 S TOWNE SQ, SUITE E, SAINT LOUIS, MO 63123-7816
(314) 487-4537
Mailing address
4 HAVEN VIEW DR, CREVE COEUR, MO 63141-7902
(314) 603-3794
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-066358
IL
207P00000X
Emergency Medicine Physician
Primary
R3G19
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205710155
—
MO
Enumeration date
12/19/2005
Last updated
06/03/2011
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