Provider Demographics
NPI:1730140179
Name:DAWKINS, EARL (PHYSIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:DAWKINS
Suffix:
Gender:M
Credentials:PHYSIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 RT 9W
Mailing Address - Street 2:
Mailing Address - City:WEST COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12192-3605
Mailing Address - Country:US
Mailing Address - Phone:518-731-9000
Mailing Address - Fax:518-731-9119
Practice Address - Street 1:11835 RT 9W
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-3605
Practice Address - Country:US
Practice Address - Phone:518-731-9000
Practice Address - Fax:518-731-9119
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01874937Medicaid
NY01874937Medicaid