Basic Information
| Provider Information | |||||||||
| NPI: | 1558897579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAWLINGS | ||||||||
| FirstName: | TANNER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 REPUBLIC PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751506917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146928262 | ||||||||
| FaxNumber: | 2148535900 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 ROCKWALL PKWY STE 110 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750326871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724946764 | ||||||||
| FaxNumber: | 9724946893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | T7337 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.