Provider Demographics
NPI:1982392635
Name:DAWBER, CALLY BAKER
Entity Type:Individual
Prefix:
First Name:CALLY
Middle Name:BAKER
Last Name:DAWBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HARBOUR POINT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5607
Mailing Address - Country:US
Mailing Address - Phone:407-902-5062
Mailing Address - Fax:
Practice Address - Street 1:1201 HARBOUR POINT DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-5607
Practice Address - Country:US
Practice Address - Phone:407-902-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty