Provider Demographics
NPI:1922171776
Name:DODDS, BRIAN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LESLIE
Last Name:DODDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2657
Mailing Address - Country:US
Mailing Address - Phone:719-544-7115
Mailing Address - Fax:719-544-6242
Practice Address - Street 1:1619 N GREENWOOD
Practice Address - Street 2:SUITE 309
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2657
Practice Address - Country:US
Practice Address - Phone:719-544-7115
Practice Address - Fax:719-544-6242
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42745207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD0669947OtherANTHEM BC BS
P00140151OtherRAILROAD MEDICARE
CO93887841Medicaid
P00140151OtherRAILROAD MEDICARE
541158Medicare PIN