Healthcare Provider Details

I. General information

NPI: 1932437886
Provider Name (Legal Business Name): DAVID DAWSON III C.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE C/O OPERATING ROOM
BATON ROUGE LA
70809-3679
US

IV. Provider business mailing address

1366 STEPHENS AVE
BATON ROUGE LA
70808-3790
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4000
  • Fax: 225-763-4163
Mailing address:
  • Phone: 225-505-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberPEF.200036
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: