Provider Demographics
NPI:1669667689
Name:RICHARD B. DAWSON, M.D. AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RICHARD B. DAWSON, M.D. AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BEACH
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-636-1506
Mailing Address - Street 1:8315 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9449
Mailing Address - Country:US
Mailing Address - Phone:405-636-1506
Mailing Address - Fax:405-636-1511
Practice Address - Street 1:8315 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9449
Practice Address - Country:US
Practice Address - Phone:405-636-1506
Practice Address - Fax:405-636-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
OK9910261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100217760AMedicaid
OK4061339OtherAETNA
OK=========004OtherBLUE CROSS BLUE SHIELD