Provider Demographics
NPI:1548259310
Name:DAWSON, RANK O JR (MD)
Entity type:Individual
Prefix:DR
First Name:RANK
Middle Name:O
Last Name:DAWSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 NORTH BEND RD.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211
Mailing Address - Country:US
Mailing Address - Phone:513-662-3500
Mailing Address - Fax:513-389-4751
Practice Address - Street 1:4767 NORTH BEND RD.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211
Practice Address - Country:US
Practice Address - Phone:513-662-3500
Practice Address - Fax:513-389-4751
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350478742082S0105X, 208200000X, 207Q00000X
OH35 0478742086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937115Medicaid
OH0748126Medicare PIN
E17116Medicare UPIN
E17116Medicare UPIN