Provider Demographics
NPI:1275559593
Name:DODSON, WILLIAM EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWIN
Last Name:DODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-6120
Mailing Address - Fax:314-454-2523
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:2ND FLOOR STE D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6120
Practice Address - Fax:314-454-2523
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR48822084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO042010101Medicaid
IL0360767023Medicaid
MO042010101Medicaid
MO042010101Medicare PIN