Provider Demographics
NPI:1043249626
Name:TEETER, RAYNI L (MD)
Entity type:Individual
Prefix:
First Name:RAYNI
Middle Name:L
Last Name:TEETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2873
Mailing Address - Country:US
Mailing Address - Phone:417-626-7337
Mailing Address - Fax:417-731-3082
Practice Address - Street 1:3126 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2873
Practice Address - Country:US
Practice Address - Phone:417-626-7337
Practice Address - Fax:417-731-3082
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200353680AMedicaid
MO200692OtherANTHEM
OK200067460AMedicaid
MO207458001Medicaid
P00259947OtherRR MEDICARE
MO936584753Medicare PIN
MO200692OtherANTHEM