Provider Demographics
NPI:1306862206
Name:BODELL, DAWN M (DO)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BODELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2400 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1118
Mailing Address - Country:US
Mailing Address - Phone:541-334-3350
Mailing Address - Fax:541-284-5198
Practice Address - Street 1:2400 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1118
Practice Address - Country:US
Practice Address - Phone:541-334-3350
Practice Address - Fax:541-284-5198
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO23947208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology