Provider Demographics
NPI:1457322133
Name:DAWSON, MARK S
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVERFRONT BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8823
Mailing Address - Country:US
Mailing Address - Phone:941-748-2417
Mailing Address - Fax:941-748-3694
Practice Address - Street 1:101 RIVERFRONT BLVD STE 700
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8823
Practice Address - Country:US
Practice Address - Phone:941-748-2417
Practice Address - Fax:941-748-3694
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064729207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
25368OtherBCBS
FL003895400Medicaid
6700971004OtherCIGNA
2905294OtherUNITED HEALTH CARE
4626267OtherAETNA PPO
667655OtherAETNA HMO
110095462OtherRAILROAD MEDICARE