Healthcare Provider Details

I. General information

NPI: 1356576946
Provider Name (Legal Business Name): JEREMIAH REED HOLMES DAWSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MADRONE ST
WILLITS CA
95490-4249
US

IV. Provider business mailing address

84 MADRONE ST
WILLITS CA
95490-4249
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-6855
  • Fax:
Mailing address:
  • Phone: 707-841-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-23003
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA126985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: