Provider Demographics
NPI:1053340505
Name:DAWSON, DAVID WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WARREN
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30739
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140
Mailing Address - Country:US
Mailing Address - Phone:405-610-3600
Mailing Address - Fax:405-610-3607
Practice Address - Street 1:511 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2439
Practice Address - Country:US
Practice Address - Phone:405-654-0013
Practice Address - Fax:405-654-0012
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
731725020OtherCHAMPUS
OK100130360AMedicaid
OK100130360AMedicaid
OK100130360AMedicaid
OK$$$$$$$$$003OtherBLUE CROSS BLUE SHIELD