Provider Demographics
NPI:1639240286
Name:DODSON, LEONARD EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:EDWIN
Last Name:DODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:EDWIN
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:STE 400
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-358-8331
Mailing Address - Fax:
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:STE 400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-358-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2359207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100662903Medicaid
TX8C6543Medicare ID - Type Unspecified
TXC15299Medicare UPIN