Provider Demographics
NPI:1790890259
Name:DAWSON, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
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 1:2900 E 29TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2603
Mailing Address - Country:US
Mailing Address - Phone:979-776-5602
Mailing Address - Fax:979-776-5265
Practice Address - Street 1:2900 E 29TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2603
Practice Address - Country:US
Practice Address - Phone:979-776-5602
Practice Address - Fax:979-776-5265
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6399207V00000X, 207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097068302Medicaid
TX097068302Medicaid
TXG46508Medicare UPIN