Provider Demographics
NPI:1942530951
Name:DWIGHT G. A. DAWKINS, MD, PA
Entity Type:Organization
Organization Name:DWIGHT G. A. DAWKINS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:GA
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-461-1191
Mailing Address - Street 1:2100 NEBRASKA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4831
Mailing Address - Country:US
Mailing Address - Phone:772-461-1191
Mailing Address - Fax:772-461-1180
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4831
Practice Address - Country:US
Practice Address - Phone:772-461-1191
Practice Address - Fax:772-461-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY069AMedicare PIN