Provider Demographics
NPI:1669794731
Name:MARK A. DODSON PLLC
Entity type:Organization
Organization Name:MARK A. DODSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-853-5678
Mailing Address - Street 1:1521 S STAPLES ST STE 605A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3166
Mailing Address - Country:US
Mailing Address - Phone:361-853-5678
Mailing Address - Fax:361-853-5680
Practice Address - Street 1:1521 S STAPLES ST STE 605A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3166
Practice Address - Country:US
Practice Address - Phone:361-853-5678
Practice Address - Fax:361-853-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty