Provider Demographics
NPI:1033530605
Name:DODDS, BRANDON T (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:T
Last Name:DODDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5415
Mailing Address - Country:US
Mailing Address - Phone:501-663-6455
Mailing Address - Fax:501-978-1575
Practice Address - Street 1:710 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4832
Practice Address - Country:US
Practice Address - Phone:501-278-2800
Practice Address - Fax:501-278-8317
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-546363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203138795Medicaid