Healthcare Provider Details

I. General information

NPI: 1275559593
Provider Name (Legal Business Name): WILLIAM EDWIN DODSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL 2ND FLOOR STE D
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6120
  • Fax: 314-454-2523
Mailing address:
  • Phone: 314-454-6120
  • Fax: 314-454-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR4882
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: