MEDICARE: BRANDON T DODDS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-546	AR
2	363AM0700X	Medical Physician Assistant	PA-546	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033530605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON T DODDS PA-C

Provider Business Mailing Address
First Line	:	5 SAINT VINCENT CIR STE 100
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5415
Country	:	US
Telephone Number	:	501-663-6455
Fax Number	:	501-978-1575

Provider Business Practice Location Address
First Line	:	710 MARION ST
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4832
Country	:	US
Telephone Number	:	501-278-2800
Fax Number	:	501-278-8317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	08/04/2021

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Directions to “ BRANDON T DODDS PA-C” Practice Location

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