Provider Demographics
NPI:1750493482
Name:DODSON, C.CALVERT III (MD)
Entity type:Individual
Prefix:DR
First Name:C.CALVERT
Middle Name:
Last Name:DODSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CAL
Other - Middle Name:
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 OFFICE PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2418
Mailing Address - Country:US
Mailing Address - Phone:205-599-3860
Mailing Address - Fax:205-599-3869
Practice Address - Street 1:200 OFFICE PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2418
Practice Address - Country:US
Practice Address - Phone:205-599-3860
Practice Address - Fax:205-599-3869
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051082025OtherBLUE CROSS OF ALABAMA
ALC73283Medicare UPIN
AL000082025Medicare ID - Type Unspecified