Provider Demographics
NPI:1164492005
Name:DAWKINS, DWIGHT GARFIELD (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:GARFIELD
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 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:STE B-109
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7550
Mailing Address - Country:US
Mailing Address - Phone:772-337-9473
Mailing Address - Fax:772-337-0796
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4832
Practice Address - Country:US
Practice Address - Phone:772-461-1191
Practice Address - Fax:772-461-1180
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44433OtherBLUE CROSS BLUE SHIELD
FL272573800Medicaid
H23935Medicare UPIN
FL44433OtherBLUE CROSS BLUE SHIELD