Provider Demographics
NPI:1649653544
Name:AL-ODAT, RAWAN T (MD)
Entity type:Individual
Prefix:MISS
First Name:RAWAN
Middle Name:T
Last Name:AL-ODAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 COPPER AVE NE
Mailing Address - Street 2:APT. 516
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123
Mailing Address - Country:US
Mailing Address - Phone:505-353-1041
Mailing Address - Fax:
Practice Address - Street 1:300 WERNER ST.
Practice Address - Street 2:CHI ST. VINCENT
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:505-622-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-13224208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist