Basic Information
| Provider Information | |||||||||
| NPI: | 1316955024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1730 PRAIRIE CITY RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956309594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163514800 | ||||||||
| FaxNumber: | 9163514899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E4614 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000810708989 | 01 | CA | PHCS | OTHER | 4029517 | 01 | CA | CIGNA | OTHER | 2583359 | 01 | CA | UNITED HEALTHCARE | OTHER | 1927452 | 01 | CA | GREAT WEST | OTHER | 256753 | 01 | CA | INTERPLAN | OTHER | 5634981 | 01 | CA | FIRST HEALTH | OTHER | 7673746 | 01 | CA | AETNA | OTHER | E4614 | 01 | CA | BLUE CROSS | OTHER | 000E46140 | 05 | CA | MEDICAID | 111434 | 01 | CA | HEALTH NET | OTHER | 000E46140 | 01 | CA | BLUE SHIELD | OTHER | 90198024 | 01 | CA | PACIFICARE | OTHER | MCMG4189000 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER |