Provider Demographics
NPI:1255339818
Name:DAWSON, WILLIAM N JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:DAWSON
Suffix:JR
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 1:130 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3253
Mailing Address - Country:US
Mailing Address - Phone:775-329-4124
Mailing Address - Fax:
Practice Address - Street 1:130 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3253
Practice Address - Country:US
Practice Address - Phone:775-329-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2992207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880167036A019OtherTRICARE
NVCC2992OtherBLUE CROSS BLUE SHIELD
CAFS4900312Medicaid
NV002016096Medicaid
NV140001565Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAFS4900312Medicaid
NVC95948Medicare UPIN