Basic Information
| Provider Information | |||||||||
| NPI: | 1932437886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | C.C.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1366 STEPHENS AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708083790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255052238 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | C/O OPERATING ROOM | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634000 | ||||||||
| FaxNumber: | 2257634163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2009 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | PEF.200036 | LA | Y | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.