Provider Demographics
NPI:1194793018
Name:RAYNER, JAMES R J (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R J
Last Name:RAYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11291207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI08-01-2007OtherNHPRI
RI04/15/2009OtherUNITED HEALTHCARE
RI7056038Medicaid
MA12/29/2009OtherTUFTS HEALTH PLAN
RI411945OtherBLUE CHIP
RI1994793018OtherNPI
MA2110130Medicaid
RIP00671203OtherRAILROAD MEDICARE
RI007057849OtherRI MEDICARE
MA2110130Medicaid