Basic Information
| Provider Information | |||||||||
| NPI: | 1497728612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4925 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503054925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152474445 | ||||||||
| FaxNumber: | 5156438933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 6TH AVE | ||||||||
| Address2: | PEDIATRIC EMERGENCY DEPARTMENT | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152474445 | ||||||||
| FaxNumber: | 5156438933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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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 | 2080P0204X | 28383 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 203721006 | 05 | MO | MEDICAID | 0075515 | 05 | IA | MEDICAID |