Provider Demographics
NPI:1396858882
Name:GEORGE-MAYO, DAWN (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GEORGE-MAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3534
Mailing Address - Country:US
Mailing Address - Phone:830-426-7947
Mailing Address - Fax:830-426-7860
Practice Address - Street 1:1200 BROOKLYN AVE
Practice Address - Street 2:STE 365
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4803
Practice Address - Country:US
Practice Address - Phone:210-225-5930
Practice Address - Fax:210-476-0246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039765504Medicaid
TX8C0218Medicare PIN
TXG78056Medicare UPIN
TX039765504Medicaid