MEDICARE: DR. HOLLY JEAN DAWSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	4942	OK
2	207V00000X	Obstetrics & Gynecology Physician	OP60930140	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4942	OTHER	OK	OK LICENSE

General Provider Information

NPI Number	:	1265761381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY JEAN DAWSON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 5299
Second Line	:	MS: 820-5-PCO
City	:	TACOMA
State	:	WA
Zip	:	98415-0299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 MCPHEE RD SW BLDG 1
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5080
Country	:	US
Telephone Number	:	360-705-1259
Fax Number	:	360-705-2757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2009
Last Update Date	:	07/22/2025

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