Healthcare Provider Details

I. General information

NPI: 1780786285
Provider Name (Legal Business Name): LIANA ELLYN DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROUND ROCK AVE
ROUND ROCK TX
78681
US

IV. Provider business mailing address

3000 N IH 35 STE 610
AUSTIN TX
78705-1850
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-1000
  • Fax:
Mailing address:
  • Phone: 512-681-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME986924
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK0451
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number059978
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME98624
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number70079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: