Healthcare Provider Details

I. General information

NPI: 1730140179
Provider Name (Legal Business Name): EARL DAWKINS PHYSIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 RT 9W
WEST COXSACKIE NY
12192-3605
US

IV. Provider business mailing address

11835 RT 9W
WEST COXSACKIE NY
12192-3605
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-9000
  • Fax: 518-731-9119
Mailing address:
  • Phone: 518-731-9000
  • Fax: 518-731-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: