Provider Demographics
NPI:1366450744
Name:DAWSON, THOMAS S (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18151 68TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2835
Mailing Address - Country:US
Mailing Address - Phone:425-485-6561
Mailing Address - Fax:
Practice Address - Street 1:18151 68TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2835
Practice Address - Country:US
Practice Address - Phone:425-485-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192464OtherLABOR & INDUSTRIES
WA2883DAOtherREGENCE BLUE SHIELD
WA192464OtherLABOR & INDUSTRIES
WAE32778Medicare UPIN