Provider Demographics
NPI:1376513408
Name:DAWSON, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1247 NE MEDICAL CENTER DR
Mailing Address - Street 2:3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3786
Mailing Address - Country:US
Mailing Address - Phone:541-318-4249
Mailing Address - Fax:541-312-5230
Practice Address - Street 1:18 NW OREGON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2735
Practice Address - Country:US
Practice Address - Phone:541-318-4249
Practice Address - Fax:541-312-5230
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD21535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130342Medicaid
ORG18443Medicare UPIN
OR130342Medicaid