Healthcare Provider Details

I. General information

NPI: 1316034036
Provider Name (Legal Business Name): MELVIN G DODSON III MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 N COURTENAY PKWY BREVARD COUNTY HEALTH DEPARTMENT
MERRITT ISLAND FL
32953
US

IV. Provider business mailing address

2575 N COURTENAY PKWY BREVARD COUNTY HEALTH DEPARTMENT
MERRITT ISLAND FL
32953
US

V. Phone/Fax

Practice location:
  • Phone: 321-454-7148
  • Fax: 321-449-5015
Mailing address:
  • Phone: 321-454-7148
  • Fax: 321-449-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME13578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: