Provider Demographics
NPI:1932291978
Name:DAWSON, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
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 1:67-1123 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8451
Mailing Address - Country:US
Mailing Address - Phone:808-885-0342
Mailing Address - Fax:808-885-1795
Practice Address - Street 1:67-1123 MAMALAHOA HWY
Practice Address - Street 2:SUITE 128
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-885-0342
Practice Address - Fax:808-885-1795
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2809207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000043299OtherHMSA
HI03948901Medicaid
HI03948901Medicaid
HIC98405Medicare UPIN