Provider Demographics
NPI:1205843638
Name:DODSON, JESSE AARON (PA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:AARON
Last Name:DODSON
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD
Mailing Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD
Practice Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER RHC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-07-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2771029Medicare PIN