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NPI Code Detail

MEDICARE: DR. LORRAINE M DODSON M.D.

MEDICARE:  DR. LORRAINE M DODSON  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
1174400000XSpecialistR5P04MO
2207V00000XObstetrics & Gynecology PhysicianR5P04MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13920OTHERMOBNDD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619970761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORRAINE M DODSON M.D.
Provider Business Mailing Address
First Line : 2016 S MAIN ST
Second Line :
City : MARYVILLE
State : MO
Zip : 64468-2655
Country : US
Telephone Number : 660-562-7918
Fax Number : 660-562-7946
Provider Business Practice Location Address
First Line : 2016 S MAIN ST
Second Line :
City : MARYVILLE
State : MO
Zip : 64468-2655
Country : US
Telephone Number : 660-562-7918
Fax Number : 660-562-7946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/07/2023

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Directions to “ DR. LORRAINE M DODSON M.D.” Practice Location

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