Provider Demographics
NPI:1215190400
Name:DODD, JOHN G (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:DODD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 MEDICAL CENTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2751
Mailing Address - Country:US
Mailing Address - Phone:503-581-5287
Mailing Address - Fax:503-588-6843
Practice Address - Street 1:655 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2751
Practice Address - Country:US
Practice Address - Phone:503-581-5287
Practice Address - Fax:503-588-6843
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO153933207W00000X
MI5101017970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500636342Medicaid
OR500636342Medicaid
ORR160193Medicare PIN