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General NPI Number Information
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NPI Number | 1013992411
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Entity Type | Individual
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Provider Name | DEREK J DAWSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 8256 HOHMAN AVE
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City | MUNSTER
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State | IN
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Zip | 46321-1516
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Country | US
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Telephone | 219-836-2770
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Fax | 219-836-0438
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Provider Business Mailing Address
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Address Line | 536 W 55TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2010
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Country | US
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Telephone | 219-836-2770
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Fax | 219-836-0438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01033635A
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License Number State | IN
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