Basic Information
| Provider Information | |||||||||
| NPI: | 1396858882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGE-MAYO | ||||||||
| FirstName: | DAWN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 AVENUE E | ||||||||
| Address2: | |||||||||
| City: | HONDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788613534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304267947 | ||||||||
| FaxNumber: | 8304267860 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 BROOKLYN AVE | ||||||||
| Address2: | STE 365 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782124803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102255930 | ||||||||
| FaxNumber: | 2104760246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | K4896 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 039765504 | 05 | TX | MEDICAID |