Healthcare Provider Details

I. General information

NPI: 1649284779
Provider Name (Legal Business Name): PHILLIP R DAWKINS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MEMORIAL DR
JASPER IN
47546-2625
US

IV. Provider business mailing address

950 MEMORIAL DR
JASPER IN
47546-2625
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-5656
  • Fax:
Mailing address:
  • Phone: 812-482-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01024458A
License Number StateIN

VIII. Authorized Official

Name: DR. PHILLIP R DAWKINS
Title or Position: OWNER
Credential:
Phone: 812-482-5656