Healthcare Provider Details

I. General information

NPI: 1699966358
Provider Name (Legal Business Name): JEFFREY DODD MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10051 LAKE AVE SUITE 3
TRUCKEE CA
96161-4825
US

IV. Provider business mailing address

10051 LAKE AVE SUITE 3
TRUCKEE CA
96161-4825
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-7461
  • Fax: 530-587-1149
Mailing address:
  • Phone: 530-587-7461
  • Fax: 530-587-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA81163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA81163
License Number StateCA

VIII. Authorized Official

Name: LAURA SMALL
Title or Position: MANAGER
Credential:
Phone: 530-587-7461