Healthcare Provider Details

I. General information

NPI: 1053340505
Provider Name (Legal Business Name): DAVID WARREN DAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 1ST ST
CHANDLER OK
74834-2439
US

IV. Provider business mailing address

PO BOX 30739
MIDWEST CITY OK
73140
US

V. Phone/Fax

Practice location:
  • Phone: 405-654-0013
  • Fax: 405-654-0012
Mailing address:
  • Phone: 405-610-3600
  • Fax: 405-610-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17752
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: