Provider Demographics
NPI:1558757435
Name:DODSON, BYRON (DO)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:DODSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1103
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-599-1448
Mailing Address - Fax:304-599-5335
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1103
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1143
Practice Address - Country:US
Practice Address - Phone:304-599-1448
Practice Address - Fax:304-599-5335
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT016274208600000X
WV3533208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery