Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 274929 | MA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q9334 | TX |
NPI | 1265876452 |
---|---|
Provider Name | William Taylor Dodgen |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 13/04/2021 |