Provider Demographics
NPI:1396788071
Name:RAWSON, RICHARD L (CRNA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:RAWSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9304 BENNIE LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6917
Mailing Address - Country:US
Mailing Address - Phone:423-954-1784
Mailing Address - Fax:
Practice Address - Street 1:9304 BENNIE LN
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6917
Practice Address - Country:US
Practice Address - Phone:423-954-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9879367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3625086Medicaid
TN430077867OtherRAILROAD MEDICARE
TN4055593OtherBLUECROSS
TN3625080Medicare ID - Type Unspecified