Provider Demographics
NPI:1871944165
Name:WOODLANDS OBSTETRICS AND GYNECOLOGY PLLC
Entity type:Organization
Organization Name:WOODLANDS OBSTETRICS AND GYNECOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:MR
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-363-4445
Mailing Address - Street 1:1001 MEDICAL PLAZA DR.
Mailing Address - Street 2:SUITE 280
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3209
Mailing Address - Country:US
Mailing Address - Phone:281-363-4445
Mailing Address - Fax:281-292-4419
Practice Address - Street 1:1001 MEDICAL PLAZA DR.
Practice Address - Street 2:SUITE 280
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3209
Practice Address - Country:US
Practice Address - Phone:281-363-4445
Practice Address - Fax:281-292-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123110206Medicaid
TXTXB101617Medicare PIN