Provider Demographics
NPI:1053314195
Name:DODD, JOSEPH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:DODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S ASH
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772
Mailing Address - Country:US
Mailing Address - Phone:417-448-3644
Mailing Address - Fax:417-448-3604
Practice Address - Street 1:800 S ASH
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772
Practice Address - Country:US
Practice Address - Phone:417-448-3644
Practice Address - Fax:417-448-3604
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058426D208600000X
MO2010005697208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1701078OtherUNITED HEALTH CARE
602049OtherFAMILY HEALTH PLAN
00789OtherPARAMOUNT
MI104389781OtherMICHIGAN MEDICAID
4196773OtherAETNA
000000223916OtherANTHEM
602049OtherBUCKEYE COMMUNITY HEALTH PLAN
OH020052286OtherRAI ROAD MEDICARE
211400OtherNATIONWIDE
OH0749024Medicaid
341966854OtherCIGNA
00789OtherPARAMOUNT
MI104389781OtherMICHIGAN MEDICAID
1701078OtherUNITED HEALTH CARE
OH0749024Medicaid
D72056Medicare UPIN
OHD72056Medicare UPIN