Clyde Dawson, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

36-063983 Issued in IL

Practice address

2100 Glenwood Ave
Joliet, IL 60435-5487

Phone

(815) 725-2121

Fax

(815) 741-6303

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443657600000",
    "number": "1174557086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740018",
            "telephone_number": "815-725-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355487",
            "telephone_number": "815-725-2121",
            "fax_number": "815-741-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAWSON",
        "first_name": "CLYDE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "36-063983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36063983",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David J.Casper,OD. (Joliet Vision Care Center)
• David Rotter Prosthetics, LTD
• Pia Davis
• Shadequia Davis, MS, NCSP
• Alishia Davison, PA-C
• Tuesday Dawson, MSW
• Tania Decker
• Carley Decore
• Deerbrook Care Center LP
• Carrie Defuss

• Surgery Physician in Joliet, IL
• Providers in Joliet, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.