Provider Demographics
NPI:1629053442
Name:DAWKINS, MAX REID (PA-C)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:REID
Last Name:DAWKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:IMMEDIATE CARE DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8219
Mailing Address - Fax:850-863-8249
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:IMMEDIATE CARE DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8219
Practice Address - Fax:850-863-8249
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0003067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY00KLOtherBCBSFL
FL290385700Medicaid
S55371Medicare UPIN
FL290385700Medicaid