Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 42049 | MN |
NPI | 1134212533 |
---|---|
Provider Name | Jawhar Rawwas |
First Address | Roseville, MN 55113 |
Second Address | Minneapolis, MN 55404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88774900 | (05) | MN |
G09999 | (02) |