Provider Demographics
NPI:1104022821
Name:JEFFREY RAWNSLEY, M.D., INC
Entity Type:Organization
Organization Name:JEFFREY RAWNSLEY, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RAWNSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-459-9966
Mailing Address - Street 1:547 CHAPALA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4430
Mailing Address - Country:US
Mailing Address - Phone:310-459-9966
Mailing Address - Fax:
Practice Address - Street 1:924 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:90024-2926
Practice Address - Country:US
Practice Address - Phone:310-570-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78843207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty