MEDICARE: RAWAH TANNOUS 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	207R00000X	Internal Medicine Physician	M2145	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114932282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAWAH TANNOUS MD

Provider Business Mailing Address
First Line	:	PO BOX 26726
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:	512-407-8686
Fax Number	:	512-421-4489

Provider Business Practice Location Address
First Line	:	1807 W SLAUGHTER LN #490
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6208
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-292-5144

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/14/2011

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Directions to “ RAWAH TANNOUS MD” Practice Location

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