MEDICARE: JOHN M. DAWSON D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E4614	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000810708989	OTHER	CA	PHCS
2	4029517	OTHER	CA	CIGNA
3	2583359	OTHER	CA	UNITED HEALTHCARE
4	1927452	OTHER	CA	GREAT WEST
5	256753	OTHER	CA	INTERPLAN
6	5634981	OTHER	CA	FIRST HEALTH
7	7673746	OTHER	CA	AETNA
8	E4614	OTHER	CA	BLUE CROSS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	111434	OTHER	CA	HEALTH NET
11	000E46140	OTHER	CA	BLUE SHIELD
12	90198024	OTHER	CA	PACIFICARE
13	MCMG4189000	OTHER	CA	WESTERN HEALTH ADVANTAGE

General Provider Information

NPI Number	:	1316955024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M. DAWSON D.P.M.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 PRAIRIE CITY RD
Second Line	:	SUITE 120
City	:	FOLSOM
State	:	CA
Zip	:	95630-9594
Country	:	US
Telephone Number	:	916-351-4800
Fax Number	:	916-351-4899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/10/2015

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