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NPI Code Detail

MEDICARE: MICHAEL O DODD MS

MEDICARE: MICHAEL O DODD MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist91-17EAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15T974OTHERARBLUE CROSS

General Provider Information

NPI Number : 1821066374
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL O DODD MS
Provider Business Mailing Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number :
Provider Business Practice Location Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 08/14/2008

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Directions to “ MICHAEL O DODD MS” Practice Location

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