Healthcare Provider Details

I. General information

NPI: 1538165113
Provider Name (Legal Business Name): PAUL MELTON DODD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLYDE MORRIS BLVD STE 450 FLORIDA CANCER SPECIALISTS P L
ORMOND BEACH FL
32174-8179
US

IV. Provider business mailing address

PO BOX 102222 ATTN: CREDENTIALING DEPT
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-2442
  • Fax: 386-673-4884
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME78210
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME78210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: