Provider Demographics
NPI:1114909405
Name:DAWKINS, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DAWKINS
Suffix:
Gender:M
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:DEPT 96-0317
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0317
Mailing Address - Country:US
Mailing Address - Phone:405-521-1969
Mailing Address - Fax:405-521-1979
Practice Address - Street 1:13174 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3017
Practice Address - Country:US
Practice Address - Phone:405-721-5555
Practice Address - Fax:405-470-7093
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19539207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$PMedicare PIN
OKG66327Medicare UPIN