Provider Demographics
NPI:1962898833
Name:RAINES, JEFFREY KENT (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:RAINES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 SW 87TH AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2319
Mailing Address - Country:US
Mailing Address - Phone:305-595-4447
Mailing Address - Fax:305-248-6320
Practice Address - Street 1:9150 SW 87TH AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2319
Practice Address - Country:US
Practice Address - Phone:305-595-4447
Practice Address - Fax:305-248-6320
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2023-08-04
Deactivation Date:2022-11-29
Deactivation Code:
Reactivation Date:2023-08-04
Provider Licenses
StateLicense IDTaxonomies
FL171950246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2086850OtherCLIA
FL57079OtherAMERICAN REGISTRY OF DIAGNOSTIC MEDICAL SONOGRAPHERS
FL171950OtherFLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE