Healthcare Provider Details

I. General information

NPI: 1457330680
Provider Name (Legal Business Name): TEDD EUGENE DAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 S MAIN ST
WILLITS CA
95490-4304
US

IV. Provider business mailing address

1196 S MAIN ST
WILLITS CA
95490-4304
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-3070
  • Fax:
Mailing address:
  • Phone: 707-459-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC38007
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC38007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: