Provider Demographics
NPI:1366450264
Name:DODD, JEFFREY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:DODD
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 1:10051 LAKE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161
Mailing Address - Country:US
Mailing Address - Phone:530-587-7461
Mailing Address - Fax:530-587-1149
Practice Address - Street 1:10051 LAKE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:530-587-7461
Practice Address - Fax:530-587-1149
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81163207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00089905OtherRAILROAD MEDICARE
CA00A811630Medicaid
ZZZ31109ZOtherMEDICARE ID TYPE UNSPECIFIED
CA00A811630Medicaid
5245670001Medicare NSC