Provider Demographics
NPI:1194757443
Name:DAWSON, TIMOTHY CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:CHARLES
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1300 S ELISEO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2014
Mailing Address - Country:US
Mailing Address - Phone:415-461-7246
Mailing Address - Fax:
Practice Address - Street 1:1300 S ELISEO DR STE 100
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2014
Practice Address - Country:US
Practice Address - Phone:415-461-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89902207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A899020Medicaid
CA1194757443OtherNPI
CA00A899022OtherMEDICARE ID
CA00A899022OtherMEDICARE ID