Provider Demographics
NPI:1609396845
Name:DODD, JACOB GERALD (DO)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:GERALD
Last Name:DODD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:GRAFENWOEHR ARMY HEALTH CLINIC
Mailing Address - Street 2:TOWER BARRACKS BUILDING 475
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114
Mailing Address - Country:US
Mailing Address - Phone:314-590-3014
Mailing Address - Fax:
Practice Address - Street 1:GRAFENWOEHR ARMY HEALTH CLINIC
Practice Address - Street 2:TOWER BARRACKS BUILDING 475
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114
Practice Address - Country:US
Practice Address - Phone:314-590-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1928207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology