Healthcare Provider Details

I. General information

NPI: 1669667689
Provider Name (Legal Business Name): RICHARD B. DAWSON, M.D. AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 S WALKER AVE
OKLAHOMA CITY OK
73139-9449
US

IV. Provider business mailing address

8315 S WALKER AVE
OKLAHOMA CITY OK
73139-9449
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-1506
  • Fax: 405-636-1511
Mailing address:
  • Phone: 405-636-1506
  • Fax: 405-636-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number9910
License Number StateOK

VIII. Authorized Official

Name: DR. RICHARD BEACH DAWSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-636-1506