Individual
DR. JAMES HARRISON RAYBOURN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 859-7222
Mailing address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 807-1262
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01073813A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000876695
ANTHEM
IN
01
—
100194370
MEDICAID GROUP NUMBER
IN
01
—
1487680518
GROUP NPI
IN
05
—
201227520
—
IN
Enumeration date
04/10/2009
Last updated
01/19/2024
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