Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 65 006511 | NY |
Y | 213ES0000X | Sports Medicine | 65 006511 | NY |
NPI | 1063763522 |
---|---|
Provider Name | Dr. Brian Dawson |
First Address | Smithtown, NY 11787-3122 |
Second Address | Smithtown, NY 11787-3122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 25/09/2012 |