Provider Demographics
NPI:1265508774
Name:DAWSON, ANITA TABOR (DO)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:TABOR
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1798 MIDLAND TR
Mailing Address - Street 2:US RT 60E
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9507
Mailing Address - Country:US
Mailing Address - Phone:304-743-5111
Mailing Address - Fax:304-743-9324
Practice Address - Street 1:1798 MIDLAND TR
Practice Address - Street 2:US RT 60E
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-9507
Practice Address - Country:US
Practice Address - Phone:304-743-5111
Practice Address - Fax:304-743-9324
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0578262Medicare ID - Type Unspecified
WVB42680Medicare UPIN