Provider Demographics
NPI:1437152303
Name:RAINS, PAUL DE VRIES (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DE VRIES
Last Name:RAINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-7943
Mailing Address - Country:US
Mailing Address - Phone:573-663-2571
Mailing Address - Fax:573-663-2779
Practice Address - Street 1:350 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-7943
Practice Address - Country:US
Practice Address - Phone:573-663-2571
Practice Address - Fax:573-663-2779
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3M48207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO597719509Medicaid
MOE09732Medicare UPIN
MO597719509Medicaid