MEDICARE: DR. STACEY LAWRENCE RAWLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2006-00772	NC
2	2084N0400X	Neurology Physician	Q4831	TX

General Provider Information

NPI Number	:	1043249774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY LAWRENCE RAWLS MD

Provider Business Mailing Address
First Line	:	16310 TOMBALL PKWY UNIT 1503
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	832-301-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	16310 TOMBALL PKWY UNIT 1503
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	832-301-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/30/2024

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