Provider Demographics
NPI:1013486265
Name:DODSON, TANNER M (DPM)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:M
Last Name:DODSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 PIONEER WOODS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7552
Mailing Address - Country:US
Mailing Address - Phone:402-489-4700
Mailing Address - Fax:402-489-5220
Practice Address - Street 1:4130 PIONEER WOODS DR STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7552
Practice Address - Country:US
Practice Address - Phone:402-489-4700
Practice Address - Fax:402-489-5220
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE385213ES0103X
IL135.001028213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL135.001028OtherSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION