Provider Demographics
NPI:1104876507
Name:RAYNOR, STEPHEN C (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
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:CHILDREN'S HOSPITAL
Mailing Address - Street 2:8200 DODGE STREET
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:405-955-5400
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL - PEDIATRIC SURGERY
Practice Address - Street 2:8200 DODGE STREET
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-7400
Practice Address - Fax:402-955-7405
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE166992086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
580OtherMIDLANDS CHOICE
269802OtherCOVENTRY
4082052OtherAETNA
NE01204OtherBCBS
17-00016OtherUHC
IA2946772Medicaid
269802OtherCOVENTRY