Provider Demographics
NPI:1790703072
Name:DAWSON, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 SAVONA WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7271
Mailing Address - Country:US
Mailing Address - Phone:585-727-6632
Mailing Address - Fax:
Practice Address - Street 1:10860 SAVONA WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7271
Practice Address - Country:US
Practice Address - Phone:585-727-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177339207L00000X
FLME140855207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00372225Medicaid
NY7591323OtherAETNA PROVIDER#
2222OtherBLUE SHIELD GROUP#
G0189393590OtherBLUE CHOICE GROUP#
NY00025654801OtherUNIVERA PROVIDER#
NY01239303Medicaid
P010177339OtherBLUE CHOICE PROVIDER#
NY5300815OtherGHI PROVIDER#
MDF848OtherPREFERRED CARE
G0189393590OtherBLUE CHOICE GROUP#
NY16535AMedicare ID - Type UnspecifiedMEDICARE GROUP #
NY00372225Medicaid