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General NPI Number Information
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NPI Number | 1245804921
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Entity Type | Individual
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Provider Name | ANDREW HAWTHORN DODD DO
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Gender | Male
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 27371 S 4410 RD
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City | VINITA
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State | OK
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Zip | 74301-7953
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Country | US
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Telephone | 918-256-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S BLISS AVE
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City | TAHLEQUAH
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State | OK
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Zip | 74464-2512
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Country | US
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Telephone | 918-458-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 7736
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License Number State | OK
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