Provider Demographics
NPI:1023056132
Name:VERA, DAWN M (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:VERA
Suffix:
Gender:F
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:PO BOX 267
Mailing Address - Street 2:107 TREMONT ST
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-0267
Mailing Address - Country:US
Mailing Address - Phone:309-449-4450
Mailing Address - Fax:309-449-4488
Practice Address - Street 1:107 TREMONT ST
Practice Address - Street 2:MEDICAL ARTS PHYSICIANS
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-0267
Practice Address - Country:US
Practice Address - Phone:309-449-4450
Practice Address - Fax:309-449-4488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F28763Medicare UPIN
396330Medicare ID - Type Unspecified