Healthcare Provider Details

I. General information

NPI: 1265455471
Provider Name (Legal Business Name): RICK LYNN RAWSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N CALIFORNIA ST STE 1E
STOCKTON CA
95204-6117
US

IV. Provider business mailing address

1901 N CALIFORNIA ST
STOCKTON CA
95204-6005
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-0150
  • Fax: 209-464-7241
Mailing address:
  • Phone: 209-946-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG21883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: