Provider Demographics
NPI:1558897579
Name:RAWLINGS, TANNER
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:RAWLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 REPUBLIC PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6917
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-853-5900
Practice Address - Street 1:890 ROCKWALL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6871
Practice Address - Country:US
Practice Address - Phone:972-494-6764
Practice Address - Fax:972-494-6893
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7337208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology