Provider Demographics
NPI:1730297821
Name:DODSON, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1521 S STAPLES ST STE 605A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3166
Mailing Address - Country:US
Mailing Address - Phone:361-853-5678
Mailing Address - Fax:361-853-5680
Practice Address - Street 1:1521 S STAPLES ST STE 605A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3166
Practice Address - Country:US
Practice Address - Phone:361-853-5678
Practice Address - Fax:361-853-5680
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114177201Medicaid
C15302Medicare UPIN
TX87A354Medicare ID - Type Unspecified