Provider Demographics
NPI:1922011857
Name:DAWSON, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
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 1:1111 W 34TH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1900
Mailing Address - Country:US
Mailing Address - Phone:512-467-1600
Mailing Address - Fax:512-302-0269
Practice Address - Street 1:1111 W 34TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1900
Practice Address - Country:US
Practice Address - Phone:512-467-1600
Practice Address - Fax:512-302-0269
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE80965Medicare UPIN