Provider Demographics
NPI:1518936533
Name:DODSON, BRENNAN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:THOMAS
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 1:1648 ELLIS STREET, SUITE 301
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8811
Mailing Address - Country:US
Mailing Address - Phone:406-556-9798
Mailing Address - Fax:406-556-9795
Practice Address - Street 1:1648 ELLIS STREET, SUITE 301
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:406-556-9798
Practice Address - Fax:406-556-9795
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44270207YX0905X
MT11061207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery