Provider Demographics
NPI:1205906716
Name:RAINS, ANTHONY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:RAINS
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 1:5163 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4924
Mailing Address - Country:US
Mailing Address - Phone:425-830-3838
Mailing Address - Fax:425-663-4459
Practice Address - Street 1:5163 NE 1ST CT
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4924
Practice Address - Country:US
Practice Address - Phone:425-830-3838
Practice Address - Fax:425-663-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021268208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06826Medicare UPIN
WA8631004Medicare ID - Type Unspecified
WAAR2771904OtherDEA