MEDICARE: MR. JOE DODSON

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	207N00000X	Dermatology Physician	206493	CA

General Provider Information

NPI Number	:	1588248546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOE DODSON

Provider Business Mailing Address
First Line	:	1515 N VERMONT AVE (5TH FLOOR DERMATOLOGY)
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S PAULINA ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-7100
Fax Number	:

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

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	04/09/2026

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Directions to “ MR. JOE DODSON ” Practice Location

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