Healthcare Provider Details

I. General information

NPI: 1902850803
Provider Name (Legal Business Name): KIRK DAWSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CULLENS ST NW
YELM WA
98597-9417
US

IV. Provider business mailing address

4570 AVERY LN SE STE C-180
LACEY WA
98503
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-7761
  • Fax: 360-458-6612
Mailing address:
  • Phone: 360-528-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001279
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: