Provider Demographics
NPI:1013980861
Name:DAWKINS, ROGER MANSFIELD (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:MANSFIELD
Last Name:DAWKINS
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 1:7454 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6881
Mailing Address - Country:US
Mailing Address - Phone:954-973-0030
Mailing Address - Fax:954-973-0531
Practice Address - Street 1:7454 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-6881
Practice Address - Country:US
Practice Address - Phone:954-973-0030
Practice Address - Fax:954-973-0531
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052893500Medicaid
FLD50567Medicare UPIN
FL02579Medicare ID - Type Unspecified