Provider Demographics
NPI:1265761381
Name:DAWSON, HOLLY JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JEAN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:JEAN
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6045
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:108 LONE OAK CIR
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434
Practice Address - Country:US
Practice Address - Phone:918-478-6005
Practice Address - Fax:918-478-6020
Is Sole Proprietor?:No
Enumeration Date:2009-12-19
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4942207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4942OtherOK LICENSE