Provider Demographics
NPI:1316955024
Name:DAWSON, JOHN M (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 PRAIRIE CITY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9594
Practice Address - Country:US
Practice Address - Phone:916-351-4800
Practice Address - Fax:916-351-4899
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4614213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810708989OtherPHCS
CA4029517OtherCIGNA
CA2583359OtherUNITED HEALTHCARE
CA1927452OtherGREAT WEST
CA256753OtherINTERPLAN
CA5634981OtherFIRST HEALTH
CA7673746OtherAETNA
CAE4614OtherBLUE CROSS
CA000E46140Medicaid
CA111434OtherHEALTH NET
CA000E46140OtherBLUE SHIELD
CA90198024OtherPACIFICARE
CAMCMG4189000OtherWESTERN HEALTH ADVANTAGE
CA000E46140Medicare ID - Type Unspecified
CA256753OtherINTERPLAN