1114066131 NPI number — REBECCA M DAWSON MD

Table of content: (NPI 1639627789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114066131 NPI number — REBECCA M DAWSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
REBECCA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1114066131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 N FORBES BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85745-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-872-7536
Provider Business Mailing Address Fax Number:
520-872-7929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 N SILVERBELL RD
Provider Second Line Business Practice Location Address:
#355
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-622-5912
Provider Business Practice Location Address Fax Number:
520-791-2246
Provider Enumeration Date:
02/06/2007

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: 207R00000X , with the licence number:  MD2008-0265 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2005-0291 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 44803 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37621351 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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