Healthcare Provider Details

I. General information

NPI: 1518969567
Provider Name (Legal Business Name): JANE L. DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S MAIN ST
MARYVILLE MO
64468-2655
US

IV. Provider business mailing address

114 E SOUTH HILLS DR
MARYVILLE MO
64468-2659
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-2525
  • Fax: 660-562-7993
Mailing address:
  • Phone: 660-562-2525
  • Fax: 660-562-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR6E87
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: