Provider Demographics
NPI:1750374526
Name:CM DODSON P.C.
Entity type:Organization
Organization Name:CM DODSON P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-233-3443
Mailing Address - Street 1:725 W OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3637
Mailing Address - Country:US
Mailing Address - Phone:956-233-3443
Mailing Address - Fax:956-233-3407
Practice Address - Street 1:725 W OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3637
Practice Address - Country:US
Practice Address - Phone:956-233-3443
Practice Address - Fax:956-233-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157466701Medicaid
TX458934Medicare ID - Type Unspecified