Provider Demographics
NPI:1417251190
Name:RAWSON, THOMAS DEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DEAN
Last Name:RAWSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SW ALLAPATTAH RD
Mailing Address - Street 2:
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-4310
Mailing Address - Country:US
Mailing Address - Phone:772-597-3705
Mailing Address - Fax:
Practice Address - Street 1:2718 LEE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:239-303-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant