Provider Demographics
NPI:1265455471
Name:RAWSON, RICK LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:LYNN
Last Name:RAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6005
Mailing Address - Country:US
Mailing Address - Phone:209-946-6800
Mailing Address - Fax:
Practice Address - Street 1:1617 N CALIFORNIA ST STE 1E
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-464-0150
Practice Address - Fax:209-464-7241
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21883208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G21883Medicaid
CAA41412Medicare UPIN
CA00G21883Medicaid