Healthcare Provider Details

I. General information

NPI: 1366450744
Provider Name (Legal Business Name): THOMAS S DAWSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18151 68TH AVE NE STE 100
KENMORE WA
98028-2835
US

IV. Provider business mailing address

18151 68TH AVE NE STE 100
KENMORE WA
98028-2835
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-6561
  • Fax:
Mailing address:
  • Phone: 425-485-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00000911
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: