Healthcare Provider Details

I. General information

NPI: 1013989086
Provider Name (Legal Business Name): RUSSELL E DODDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E CALHOUN ST
ANDERSON SC
29621-5803
US

IV. Provider business mailing address

404 E CALHOUN ST
ANDERSON SC
29621-5803
US

V. Phone/Fax

Practice location:
  • Phone: 800-779-4858
  • Fax: 864-231-6448
Mailing address:
  • Phone: 800-779-4858
  • Fax: 864-231-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number14206
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number142063
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: