Provider Demographics
NPI:1942233523
Name:DODGE, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:DODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1590 W FRONTIER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3196
Mailing Address - Country:US
Mailing Address - Phone:469-296-1679
Mailing Address - Fax:692-961-6804
Practice Address - Street 1:1590 W FRONTIER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3196
Practice Address - Country:US
Practice Address - Phone:469-296-1679
Practice Address - Fax:692-961-6804
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK6565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG92251Medicare UPIN
TX00303JMedicare PIN