Healthcare Provider Details

I. General information

NPI: 1730349739
Provider Name (Legal Business Name): TEDD E DAWSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 02/25/2009
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: 707-459-3052
Mailing address:
  • Phone: 707-459-3070
  • Fax: 707-459-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TEDD EUGENE DAWSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-459-3070