MEDICARE: THOMAS DEAN RAWSON PA-C

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	363A00000X	Physician Assistant	PA9105847	FL

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

General Provider Information

NPI Number	:	1417251190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS DEAN RAWSON PA-C

Provider Business Mailing Address
First Line	:	1150 SW ALLAPATTAH RD
Second Line	:
City	:	INDIANTOWN
State	:	FL
Zip	:	34956-4310
Country	:	US
Telephone Number	:	772-597-3705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 LEE BLVD
Second Line	:	SUITE B
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-1537
Country	:	US
Telephone Number	:	239-303-9298
Fax Number	:

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	08/12/2014

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