1912096264 NPI number — DR. LORI BETH SCHLUNT RAWSON M.D.

Table of content: DR. LORI BETH SCHLUNT RAWSON M.D. (NPI 1912096264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912096264 NPI number — DR. LORI BETH SCHLUNT RAWSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAWSON
Provider First Name:
LORI
Provider Middle Name:
BETH SCHLUNT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLUNT
Provider Other First Name:
LORI
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912096264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3862 ANNANDALE CT
Provider Second Line Business Mailing Address:
STOCKTON
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95219-1776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-957-8815
Provider Business Mailing Address Fax Number:
209-957-8815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 DALE RD
Provider Second Line Business Practice Location Address:
MODESTO
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95356-9718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-735-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  A84806 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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