Healthcare Provider Details

I. General information

NPI: 1164698619
Provider Name (Legal Business Name): DAVID KIRK DODSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 02/15/2024
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NATHAN LN N
PLYMOUTH MN
55441-6306
US

IV. Provider business mailing address

28 NATHAN LN N
PLYMOUTH MN
55441-6306
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-7099
  • Fax: 763-522-2222
Mailing address:
  • Phone: 763-588-7099
  • Fax: 763-522-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number52435
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number52435
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: