=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376549139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID P RAWDON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 MEMORIAL DR STE 210
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-5373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-235-0460
-----------------------------------------------------
Fax | 618-235-1464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 MASON RIDGE CENTER DR STE 300
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-448-3791
-----------------------------------------------------
Fax | 314-996-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 036096642
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------