Provider Demographics
NPI:1134515851
Name:DODSON, DANIEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:DODSON
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:PEDIATRIC INFECTIOUS DISEASES
Mailing Address - Street 2:TICON II BUILDING, 2516 STOCKTON BLVD.
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:858-204-6891
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC INFECTIOUS DISEASES
Practice Address - Street 2:TICON II BUILDING, 2516 STOCKTON BLVD.
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:858-204-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172961208000000X, 208000000X
CODR.00635652080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10092311-8905OtherUTAH LISENCE