1144529181 NPI number — MR. WILBUR ADRIAN DAWSON II BA.

Table of content: MR. WILBUR ADRIAN DAWSON II BA. (NPI 1144529181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144529181 NPI number — MR. WILBUR ADRIAN DAWSON II BA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
WILBUR
Provider Middle Name:
ADRIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
BA.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144529181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 SIMPSON STUART RD
Provider Second Line Business Mailing Address:
APT. 15101
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75241-5065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-896-5295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8625 KING GEORGE DR
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-631-7002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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