Provider Demographics
NPI:1285244764
Name:DODDS, JAMES VANCE (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:VANCE
Last Name:DODDS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:DODDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:972 N 600 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1306
Practice Address - Country:US
Practice Address - Phone:385-265-6060
Practice Address - Fax:801-465-0606
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11666194-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant