Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D09299 | FL |
NPI | 1023029592 |
---|---|
Provider Name | Dr. Raj M Rawal |
First Address | Merritt Island, FL 32953-4236 |
Second Address | Merritt Island, FL 32953-4236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |