Healthcare Provider Details

I. General information

NPI: 1285995019
Provider Name (Legal Business Name): JOC RAWLS D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 N 91ST AVE
PEORIA AZ
85345
US

IV. Provider business mailing address

5533 N. CENTRAL AVE
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-9801
  • Fax: 623-334-5166
Mailing address:
  • Phone: 602-622-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number3650
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: