Healthcare Provider Details

I. General information

NPI: 1053554477
Provider Name (Legal Business Name): DAVID MICHAEL DAWSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-4570
  • Fax: 417-347-6755
Mailing address:
  • Phone: 417-347-4570
  • Fax: 417-347-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2012018191
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: