Provider Demographics
NPI:1134195704
Name:DAWSON, EUGENE E JR (PHD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:E
Last Name:DAWSON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 LOST CREEK RD N
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-7595
Mailing Address - Country:US
Mailing Address - Phone:970-252-3941
Mailing Address - Fax:970-240-9621
Practice Address - Street 1:2912 LOST CREEK RD N
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-7595
Practice Address - Country:US
Practice Address - Phone:970-252-3941
Practice Address - Fax:970-240-9621
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9912061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC68506Medicare PIN
COS51365Medicare UPIN