Provider Demographics
NPI:1851384465
Name:DODSON, ERIC LYNN (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LYNN
Last Name:DODSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1207 N JEFFERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2021
Practice Address - Country:US
Practice Address - Phone:641-682-5437
Practice Address - Fax:641-682-1317
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79889Medicare UPIN