Provider Demographics
NPI:1164457008
Name:RAWSON, RAYMOND BLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BLAINE
Last Name:RAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2390 MITCHELL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8965
Mailing Address - Country:US
Mailing Address - Phone:231-487-5837
Mailing Address - Fax:231-622-8771
Practice Address - Street 1:2390 MITCHELL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8965
Practice Address - Country:US
Practice Address - Phone:231-487-5837
Practice Address - Fax:231-622-8771
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086659207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P52980Medicare PIN
L41388Medicare UPIN
MI4782791Medicaid
MIMI5277Medicaid
L41388Medicare UPIN