Provider Demographics
NPI:1891824496
Name:THOMAS M DAWES JR MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS M DAWES JR MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAWES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:805-934-2488
Mailing Address - Street 1:116 S PALISADE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:825-934-2488
Mailing Address - Fax:805-934-2480
Practice Address - Street 1:116 S PALISADE DR STE 210
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:825-934-2488
Practice Address - Fax:805-934-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG87129Medicare UPIN
CAW17071Medicare ID - Type UnspecifiedGROUP