Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD00042009 | WA |
N | 207P00000X | Emergency Physician | PT15145 | ND |
Y | 207RA0401X | Internist - Addiction Medicine | PT15145 | ND |
NPI | 1871540435 |
---|---|
Provider Name | Brian Jefferson Dawson |
First Address | Federal Way, WA 98003-6328 |
Second Address | Fargo, ND 58104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 16/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0202684 | LIWA (01) | WA |
3074DA | BSWA (01) | WA |
8352197 | (05) | WA |
H83916 | (02) | WA |