Provider Demographics
NPI:1316034036
Name:DODSON, MELVIN G III (MD PHD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:G
Last Name:DODSON
Suffix:III
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2575 N COURTENAY PKWY
Mailing Address - Street 2:BREVARD COUNTY HEALTH DEPARTMENT
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:2575 N COURTENAY PKWY
Practice Address - Street 2:BREVARD COUNTY HEALTH DEPARTMENT
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-454-7148
Practice Address - Fax:321-449-5015
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME13578207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373413700Medicaid
FL71381PMedicare ID - Type Unspecified
FL373413700Medicaid