Provider Demographics
NPI:1598976011
Name:DODD, STEPHEN PAUL (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:DODD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4824
Mailing Address - Country:US
Mailing Address - Phone:432-520-3020
Mailing Address - Fax:432-699-1981
Practice Address - Street 1:4304 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4824
Practice Address - Country:US
Practice Address - Phone:432-520-3020
Practice Address - Fax:432-699-1981
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01290248OtherMEDICARE RR
TXP00605442OtherMEDICARE RAILROAD
TX8764NFOtherBCBS
TX8K1520Medicare Oscar/Certification
TX322577YN4BMedicare PIN