Provider Demographics
NPI:1598759201
Name:DAWDY, JOHN KERSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KERSEY
Last Name:DAWDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:201 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1155
Mailing Address - Country:US
Mailing Address - Phone:618-664-1380
Mailing Address - Fax:618-664-4239
Practice Address - Street 1:201 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1155
Practice Address - Country:US
Practice Address - Phone:618-664-1380
Practice Address - Fax:618-664-4239
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0036044169207Q00000X
IL036044169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044169Medicaid
ILC37999Medicare UPIN
ILC37999Medicare UPIN