Provider Demographics
NPI:1568904811
Name:DAWSON, CARLTON DOUGLAS
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:DOUGLAS
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45831
Mailing Address - Street 2:
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145-0831
Mailing Address - Country:US
Mailing Address - Phone:405-658-3255
Mailing Address - Fax:
Practice Address - Street 1:4427 DESERT VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3631
Practice Address - Country:US
Practice Address - Phone:405-658-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator