# DAWN A FAIRLEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1801832373
- **Gender:** F
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2006023529 | MO | Yes |
| 207Q00000X | Family Medicine Physician | 20A 7187 | CA | — |
| 207Q00000X | Family Medicine Physician | OS 9881 | FL | — |
| 207Q00000X | Family Medicine Physician | OS012469 | PA | — |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 04/27/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0019478700001 | — | PA |
| 05 | — | 207348905 | — | MO |
| 01 | — | 961950085 | MEDICARE ID - TYPE UNSPECIFIED | MO |