Provider Demographics
NPI:1407836224
Name:RAWSON, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:RAWSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 COLORADO AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1220
Mailing Address - Country:US
Mailing Address - Phone:763-229-7350
Mailing Address - Fax:
Practice Address - Street 1:1342 COLORADO AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1220
Practice Address - Country:US
Practice Address - Phone:952-546-5322
Practice Address - Fax:763-210-6820
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN35804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN307019100Medicaid