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NPI Code Detail

MEDICARE: RAQUEL DAWSON

MEDICARE: RAQUEL DAWSON
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
1363A00000XPhysician Assistant303849LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285178657
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAQUEL DAWSON
Provider Business Mailing Address
First Line : 1202 LOUISIANA AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3910
Country : US
Telephone Number : 318-212-8951
Fax Number : 318-212-6752
Provider Business Practice Location Address
First Line : 7925 YOUREE DR STE 200
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5134
Country : US
Telephone Number : 318-212-3610
Fax Number : 318-212-3709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2016
Last Update Date : 06/23/2021

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Directions to “ RAQUEL DAWSON ” Practice Location

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