Provider Demographics
NPI:1598497380
Name:DAWSON, WALTER RAVON
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RAVON
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 1:10244 E COLONIAL DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4338
Mailing Address - Country:US
Mailing Address - Phone:407-777-2673
Mailing Address - Fax:407-612-2226
Practice Address - Street 1:10244 E COLONIAL DR STE 204
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4338
Practice Address - Country:US
Practice Address - Phone:407-777-2673
Practice Address - Fax:407-612-2226
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4368171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist