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NPI Code Detail

MEDICARE: DIANE DODGEN M.D.

MEDICARE: DIANE DODGEN M.D.
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
1261QP2300XPrimary Care Clinic/CenterME99971FL
2207R00000XInternal Medicine PhysicianME99971FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134117385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE DODGEN M.D.
Provider Business Mailing Address
First Line : 330 BISHOP BLVD
Second Line :
City : PERRY
State : FL
Zip : 32347-3618
Country : US
Telephone Number : 850-584-3278
Fax Number : 850-584-8171
Provider Business Practice Location Address
First Line : 315 E ASH ST
Second Line :
City : PERRY
State : FL
Zip : 32347-2029
Country : US
Telephone Number : 850-584-3278
Fax Number : 850-584-8171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 03/17/2017

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Directions to “ DIANE DODGEN M.D.” Practice Location

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