MEDICARE: DR. DAVID J DODD MD

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	2086S0129X	Vascular Surgery Physician	050474	GA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME96463	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56676	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972599587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J DODD MD

Provider Business Mailing Address
First Line	:	200 AVENUE F NE STE 9118
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4131
Country	:	US
Telephone Number	:	863-292-4004
Fax Number	:	863-292-4005

Provider Business Practice Location Address
First Line	:	200 AVENUE F NE STE 9118
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4131
Country	:	US
Telephone Number	:	863-297-1777
Fax Number	:	863-297-1756

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/21/2022

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