Provider Demographics
NPI:1699090431
Name:DAUWE, PHILLIP BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BLAKE
Last Name:DAUWE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2801 LEMMON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2356
Mailing Address - Country:US
Mailing Address - Phone:214-914-1700
Mailing Address - Fax:214-821-6584
Practice Address - Street 1:2801 LEMMON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2356
Practice Address - Country:US
Practice Address - Phone:214-914-1700
Practice Address - Fax:214-821-6584
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4744208200000X
CAA138672208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery