Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 135.001028 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | 385 | NE |
NPI | 1013486265 |
---|---|
Provider Name | Tanner M Dodson |
First Address | Lincoln, NE 68506-7552 |
Second Address | Lincoln, NE 68506-7552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135.001028 | STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION (01) | IL |