Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A-101394 | NM |
N | 207X00000X | Orthopaedic Surgeon | A-101394 | NM |
NPI | 1861464844 |
---|---|
Provider Name | Dr. Douglas R Dodson |
First Address | Alamogordo, NM 88310-4607 |
Second Address | Alamogordo, NM 88310-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 28/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000L1222 | (05) | NM |
201002522 | PRESBYTERIAN (01) | NM |
F82233 | (02) | NM |
NM004006 | BLUE CROSS BLUE SHIELD (01) | NM |