Provider Demographics
NPI:1417910068
Name:DODSON, MARY R (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:DODSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 610038
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35261-0038
Mailing Address - Country:US
Mailing Address - Phone:205-655-1108
Mailing Address - Fax:205-655-1214
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-877-1930
Practice Address - Fax:205-877-1865
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00014789207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE30477Medicare UPIN