MEDICARE: SAMUEL T 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	207L00000X	Anesthesiology Physician	ME139183	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	:	1912964586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL T RAWLS MD

Provider Business Mailing Address
First Line	:	3008-A S. FLETCHER AVE.
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4597
Country	:	US
Telephone Number	:	912-270-1981
Fax Number	:	904-530-2296

Provider Business Practice Location Address
First Line	:	3008A S FLETCHER AVE
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4597
Country	:	US
Telephone Number	:	912-270-1981
Fax Number	:	904-530-2296

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	12/02/2025

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