Provider Demographics
NPI:1235116625
Name:DODSON, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
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 1:802 N RIVERSIDE RD.,
Mailing Address - Street 2:STE. 150
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4934
Mailing Address - Country:US
Mailing Address - Phone:816-271-4025
Mailing Address - Fax:816-271-4026
Practice Address - Street 1:802 N RIVERSIDE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-9794
Practice Address - Country:US
Practice Address - Phone:816-271-4025
Practice Address - Fax:816-271-4026
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008022986208100000X
ARN-6767208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100347180BMedicaid
MOP00737529OtherRR MEDICARE
MO1235116625Medicaid
IN200334900Medicaid
AR111556001Medicaid
MOP00737529OtherRR MEDICARE
IN200334900Medicaid