| Tedd E Dawson Md Inc | |
|
1196 S Main St Willits CA 95490-4304 | |
| (707) 459-3070 | |
| (707) 459-3052 |
| Full Name | Tedd E Dawson Md Inc |
|---|---|
| Speciality | Surgery |
| Location | 1196 S Main St, Willits, California |
| Authorized Official Name and Position | Tedd Eugene Dawson (PRESIDENT) |
| Authorized Official Contact | 7074593070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tedd E Dawson Md Inc 1196 S Main St Willits CA 95490-4304 Ph: (707) 459-3070 | Tedd E Dawson Md Inc 1196 S Main St Willits CA 95490-4304 Ph: (707) 459-3070 |
| NPI Number | 1730349739 |
|---|---|
| Provider Enumeration Date | 06/12/2008 |
| Last Update Date | 02/25/2009 |
| Medicare PECOS PAC ID | 3678631272 |
|---|---|
| Medicare Enrollment ID | O20081027000431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730349739 | NPI | - | NPPES |
| 1457330680 | Medicaid | CA | |
| 00C380070 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | C38007 (California) | Secondary |
| 208600000X | Surgery | C38007 (California) | Primary |
| Provider Name | Tedd E Dawson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457330680 PECOS PAC ID: 0143388744 Enrollment ID: I20081027000413 |
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