Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 40738 | IA |
NPI | 1003128141 |
---|---|
Provider Name | Khushman Dodd |
First Address | Cedar Falls, IA 50613-8155 |
Second Address | Cedar Falls, IA 50613-8155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 03/11/2017 |