Provider Demographics
NPI:1508012725
Name:DAWES, DEREK S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:S
Last Name:DAWES
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 1:5656 KELLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-1967
Mailing Address - Country:US
Mailing Address - Phone:713-566-4489
Mailing Address - Fax:713-566-5025
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-4489
Practice Address - Fax:713-566-5025
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CQ689OtherBCBSTX
TXTXB119955Medicare PIN