Provider Demographics
NPI:1891861035
Name:DODSON, BRANDT L (DPM)
Entity type:Individual
Prefix:
First Name:BRANDT
Middle Name:L
Last Name:DODSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-858-5786
Mailing Address - Fax:812-490-4512
Practice Address - Street 1:4233 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8900
Practice Address - Country:US
Practice Address - Phone:812-858-5786
Practice Address - Fax:812-490-4512
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000675A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100248490Medicaid
IN000000109422OtherANTHEM
IN000000109422OtherANTHEM
IN849840FMedicare PIN
IN480024915Medicare PIN
IN257900GGGGMedicare PIN