Provider Demographics
NPI:1033310271
Name:DODSON, DANIEL JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JACK
Last Name:DODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-3937
Mailing Address - Fax:985-230-3935
Practice Address - Street 1:15770 PAUL VEGA MD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1475
Practice Address - Country:US
Practice Address - Phone:985-230-3937
Practice Address - Fax:985-230-3935
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19793207W00000X
LAMD.026383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1057835Medicaid
LA4K941D628Medicare PIN