Provider Demographics
NPI:1114066131
Name:DAWSON, REBECCA M (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7536
Mailing Address - Fax:520-872-7929
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:#355
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-622-5912
Practice Address - Fax:520-791-2246
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0265207R00000X
NM2005-0291207R00000X
AZ44803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37621351Medicaid
NM37621351Medicaid