Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810006137 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810006137 | VA |
NPI | 1003371311 |
---|---|
Provider Name | Dr. Milton Ray Dawkins JR. |
First Address | Fpo, AP 96350-1200 |
Second Address | Yokosuka, YOKOSUKA, INAOKACHO, 82 238-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |