Provider Demographics
NPI:1225092562
Name:DODDS, MATTHEW TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TAYLOR
Last Name:DODDS
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 1:1421 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1337
Mailing Address - Country:US
Mailing Address - Phone:307-237-2511
Mailing Address - Fax:307-237-7351
Practice Address - Street 1:1421 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1337
Practice Address - Country:US
Practice Address - Phone:307-237-2511
Practice Address - Fax:307-237-7351
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4462A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104679900Medicaid
WY310643OtherBLUE CROSS BLUE SHIELD
WY104679900Medicaid
WYE78848Medicare UPIN