Basic Information
| Provider Information | |||||||||
| NPI: | 1649284779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHILLIP R DAWKINS MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475462625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124825656 | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475462625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124825656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | DAWKINS | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8124825656 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 01024458A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | DA2283 | 01 | IN | RAILROAD MEDICARE | OTHER |