Provider Demographics
NPI:1467728576
Name:DAWER, MARSHALL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:JAY
Last Name:DAWER
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 1:17431 WOODS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7541
Mailing Address - Country:US
Mailing Address - Phone:972-732-6828
Mailing Address - Fax:
Practice Address - Street 1:5800 GRANITE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6614
Practice Address - Country:US
Practice Address - Phone:469-633-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8987207R00000X
MS19196207R00000X
OK22718207R00000X
CAG46408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine