Provider Demographics
NPI:1720079940
Name:RAYBURN, SETH D (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:D
Last Name:RAYBURN
Suffix:
Gender:
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:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0630
Mailing Address - Country:US
Mailing Address - Phone:256-216-6500
Mailing Address - Fax:256-216-8777
Practice Address - Street 1:707 W MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2463
Practice Address - Country:US
Practice Address - Phone:256-216-6500
Practice Address - Fax:256-216-8777
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23684208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1720079940OtherNPI
AL051001883OtherBCBS OF AL
AL009932649Medicaid
AL1720079940OtherNPI
AL051001883OtherBCBS OF AL