Healthcare Provider Details

I. General information

NPI: 1073560702
Provider Name (Legal Business Name): PAWAN A DHAWAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BDMC/ATTN: BMG HOSPITALISTS 1400 S DOBSON ROAD
MESA AZ
85202
US

IV. Provider business mailing address

BDMC/ATTN: BMG HOSPITALISTS 1400 S DOBSON ROAD
MESA AZ
85202
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6788
  • Fax: 480-412-6848
Mailing address:
  • Phone: 480-412-6788
  • Fax: 480-412-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2016-02385
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65265
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number056681
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number2016-02385
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number65265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: