Provider Demographics
NPI:1851588966
Name:DODD, RUSTY JOHN
Entity Type:Individual
Prefix:MR
First Name:RUSTY
Middle Name:JOHN
Last Name:DODD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 MCCINDY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-0734
Mailing Address - Country:US
Mailing Address - Phone:337-438-1504
Mailing Address - Fax:
Practice Address - Street 1:7704 MCCINDY RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-0734
Practice Address - Country:US
Practice Address - Phone:337-438-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies