Provider Demographics
NPI:1528485182
Name:DAWSON, BOBBY (RPH)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SAM RAYBURN DR
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4333
Mailing Address - Country:US
Mailing Address - Phone:903-583-7325
Mailing Address - Fax:903-583-7865
Practice Address - Street 1:100 E SAM RAYBURN DR
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4333
Practice Address - Country:US
Practice Address - Phone:903-583-7325
Practice Address - Fax:903-583-7865
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459050Medicaid